Health Policy Commons^™

Budget Capping Health Care: Its Impact On Health, Susan Chen

Theses and Dissertations

The goal of a budget cap on healthcare is to constrain total healthcare expenditure without compromising quality. This paper examines the impacts of budget capping on health and behavioral health outcomes, exploiting the completed Maryland All-Payer Model and the ongoing, extensional Maryland Total Cost of Care model, both of which capped healthcare budgets in Maryland. I use data from 2011-2021 surveys of the Behavioral Risk Factor Surveillance system and generalized difference-in-difference regression models to find that budget capping improves health and behavioral health outcomes with a greater favorable effect during the Maryland Total Cost of Care model.

Applying Structural Equation Modeling To Better Understand The Relationship Between Stressors, Social Support And Wellbeing In The Lives Of Spouse Dementia Caregivers, Craig Holden

Dissertations, Theses, and Capstone Projects

Applying Structural Equation Modeling to Better Understand the Relationship Between Stressors, Social Support and Wellbeing in the Lives of Spouse Dementia Caregivers considers the utility of Pearlin et al.’s (1990) stress process model in understanding the needs of spouse caregivers. Data were drawn from eight biennial waves of the University of Michigan Health and Retirement Study (HRS) and analyzed using structural equation modeling. The final study sample comprised 774 spouses, average age 73, who were categorized based on Alzheimer’s Disease and Related Dementia (ADRD) and non-ADRD caregiver status. Results showed that for the study sample as a whole, social support …

"I Stayed There The Whole Night": Exploring Caregivers' Experiences With The Healthcare System When Caring For A Parent At The End Of Life, Lillian Mehran

Dissertations and Theses

Background: In the United States, there are nearly 53 million individuals serving as caregivers to a loved one. Half of all caregivers are caring for a parent or parent-in-law, and 79% of caregivers are caring for a person aged 50 or older. In New York State, there are an estimated 4.1 million caregivers who collectively provide over 2.6 billion hours of unpaid care, with those caring for a person at the end of life providing twice as many hours of caregiving per week compared to other caregivers. The number of individuals requiring caregiving is expected to increase as a significant …

Conservative And Cultural Clashes With Comprehensive Sexuality Education, Bryan Z. Anderson

Dissertations, Theses, and Capstone Projects

This thesis analyzes the multifaceted debate over the use of comprehensive sexuality education (CSE) in United States public schools, while also emphasizing the ways in which withholding CSE is a strategy to uphold the white supremacist patriarchy. The work begins by historically framing the evolution of sexuality education through the United States’ history. This leads to the current discourse around CSE and the ways in which it is the optimal support for American youth today. After setting this foundation, the thesis looks at conservative figures and groups who are seeking to prevent public school adoption of CSE standards, as well …

Episode Based Payment Models And The Hospital Safety-Net: An Evaluation Of The Center For Medicare And Medicaid Services’ Comprehensive Joint Replacement Bundled Payment Program, John A. Gravina

Dissertations and Theses

Episode Based Payment Models and the Hospital Safety-net: An Evaluation of the Center for Medicare and Medicaid Services’ Comprehensive Joint Replacement Bundled Payment Program

By John Anthony Gravina

Advisor: Alexis Pozen, Ph.D.

Introduction: Payments for Healthcare services are increasingly being tied to clinical quality, patient experience, health outcomes, and efficiency through value-based payment arrangements (VBP). VBP presents a potential opportunity to reduce healthcare expenditures by requiring providers to take on financial risk associated with the cost and quality of care, therefore aligning payment incentives with the goals of providing higher quality and efficient care. As of 2020, 80 percent of …

Pandemic Schooling: Lessons In Equity, Advocacy, And Racial Justice, Donna Rivera

Dissertations, Theses, and Capstone Projects

It was my fourth year of teaching at a Brooklyn elementary school when the COVID-19 pandemic forced school buildings, and the entire city, to enter a world of lockdown and quarantine. New York City was an early epicenter of the 2020 coronavirus pandemic, and the virus quickly revealed severe racial and socioeconomic disparities across the city. A disproportionate number of cases, serious illnesses, and death has been experienced by low-income Black and Latinx communities. At the same time, 2020 also ushered in a national racial reckoning following the May murder of George Floyd.

In this thesis, I will provide a …

Constructing Curriculum: Centering Identities In Sex Education, Jozette Belmont

Dissertations, Theses, and Capstone Projects

Sex education (sex ed) is a state-by-state and school-by-school issue, and there are no federal laws which mandate medically accurate education. In New York, schools only offer one semester of health education which often happens in the last semester of twelfth grade. Further, LGBTQIA+ people’s sexual health and identities are rarely mentioned. Therefore, this project asks: What are the ways sex ed curricula and policies in New York address the needs of LGBTQIA+ youth? To answer this question, I use a critical policy analysis to compare curriculum from the New York City Department of Education (NYCDOE) and Peer Health Exchange …

Impact Of 2012 Spanish Health Care Reform On Hiv-Positive Immigrants: A Mixed Methods Approach, Megi Gogishvili

Dissertations and Theses

Background: The financial crisis of 2008 hit Spain hard. As a consequence, the government took multiple austerity measures, including reforms in the healthcare system in 2012. Specifically, the government reduced the budget for health and social services by 13.7% in 2012.The reduction was further followed with structural changes via the 2012 Royal Decree Law (RDL) and Royal Decree (RD).The 2012 RDL and RD entailed broad areas of action,but most importantly the Spanish National Health System (SNS) no longer covered undocumented immigrants. The 2012 RDL and RD excluded approximately 500,000 undocumented immigrants from SNS.

The number of immigrants in Spain has …

Impacts Of Rift Valley Fever Virus: A One Health Approach To Assess Burden And Inform Prevention And Control Options, Catherine Machalaba

Dissertations and Theses

Background: Rift Valley Fever (RVF) is a climate-sensitive emerging zoonotic disease associated with large-scale livestock production losses and human disease burden in Sub-Saharan Africa and the Middle East. While recognized as a key One Health issue based on its transmission dynamics involving human, animal and environmental determinants, there has been poor coordination between sectors to reduce the risk and impact of RVF. Efforts to counter the disease remain largely reactive, presenting an ongoing threat to local and global health security. The intent of this dissertation was to improve understanding of the burden of RVF across society and to identify entry …

The Reproductive Health And Academic Impact Of The New York City School-Based Health Center Reproductive Health Project For Adolescents, Michelle Silverio

Dissertations and Theses

Background: Gaining an understanding of how school reproductive health policies impact adolescent sexual health and academic outcomes is a public health priority in the United States (U.S.) since it has the highest rates of adolescent pregnancy and sexually transmitted infections among developed nations. Adolescence is a critical developmental period and influences in this period affect reproductive health and social well-being over a person’s entire lifespan. Almost all adolescents spend the majority of their time in school settings; therefore local school reproductive health policies may have substantial lifetime impacts. Policies such as providing comprehensive sexual health education and contraceptive access in …

Shadow Standards And The Logic Of Costs: Care, Stewardship, And Data In U.S. Community Health, Margarite J. Whitten

Dissertations, Theses, and Capstone Projects

This dissertation examines the delegation of responsibility for providing health care to particular categories of marginalized populations in the United States in the absence of a uniform and universal health care system. It explores how the U.S. federal government governs patient populations at a distance by mandating that healthcare providers collect, produce, and report on patient data. Drawing from eighteen months of ethnographic research in Massachusetts clinics for the homeless and the frail elderly between 2014-2015, I argue that when marginalized patients are unable to satisfy the neoliberal ideal of self-governance to maintain their health in cost-effective ways, providers are …

Among America’S Oldest, Opioid Overdoses Are On The Rise, Emma Davis

Capstones

Often overlooked in coverage of the opioid crisis, American seniors have experienced a dramatic increase in addiction in the last two decades. Drug overdoses in adults ages 55-64 have risen six-fold since 1999, according to the Center for Disease Control, and emergency visits due to opioid misuse tripled among those over 65 from 2006-2014, a study from Towson University found. This print and video piece investigates how heroin and prescription opioid use among older adults in New York City has contributed to the overdose rate; the consequences of opioid restrictions for geriatric pain patients; and the treatment options for seniors …

The Effect Of Citi Bike Introduction On Injury Rates In New York City, Masakazu Hiruma

Theses and Dissertations

This paper tests the hypothesis that the introduction of Citi Bike influences bicycle injuries by observing the gradual expansion of the bike share system in NYC. Data is analyzed from 2012-2018 New York Police Department (NYPD) Motor Vehicle Collisions and Citi Bike Station Feeds (NYC Open Data).

Sweeping Exposures: Lead Poisonings And Black Working Poor Populations In The United States, Shirley Reid

Dissertations, Theses, and Capstone Projects

The focus of my thesis is to explore some of the realities that the impoverished urban black poor populations face in America today. The goal of my thesis is to illustrate how poverty is reproduced within impoverished neighborhoods through the idea and mechanism of lead exposure, by recognizing how specific exposure to the element lead and its by-products is both a symbol and a material cause of black urban poor illness and disability. There is no mistake that people living in the U.S. are aware of the social injustices against black populations in the form of racial injustice. However, …

Island Of Harm Reduction, Trevor T. Boyer

Capstones

New York City's Rikers Island has a medically assisted treatment (MAT) program for detainees who are addicted to opioids, providing buprenorphine or methadone. For many locked up there, though, Rikers is only a way station before a trip upstate to prison. Even now, over 30 years after its treatment program began, only six other correctional facilities in New York offer pilot opioid treatment programs, which are available only to limited segments of their respective populations.

So for those taking medication in the form or methadone or buprenorphine on Rikers Island pretrial and awaiting sentencing, they're tapered off their doses to …

Dios, Drogas, Dinero: ¿QuiéN Gana Con El Traslado De Adictos De Puerto Rico A Ee.Uu.?, Claudia E. Irizarry Aponte, Eliana Y. Perez

Capstones

For the last 25 years, evangelical leaders have been shipping off opioid addicts in Puerto Rico to cities in the mainland US, mainly New York City, Chicago and Philadelphia--under the promise they’ll receive state-of-the-art rehabilitation treatment, only to end up in unregulated transitional homes and flophouses where they don’t receive proper medical care or psychotherapy. In turn, many of these unregulated transitional homes, also run by evangelical leaders, may charge Medicaid kickbacks from their “patients.”

While this so-called “air bridge” from Puerto Rico to the U.S. goes back decades, it gained momentum from 2005 to 2014, when evangelical leaders joined …

Rates Of Developmental And Behavioral Screening Of Young Children: Implications For Health Care Policy And Practice, Shirley Berger

Dissertations and Theses

Background: The skills and capacities developed during early childhood are the foundation for a child’s future academic functioning, economic productivity, and lifelong health and mental health. When young children have developmental delays or disabilities, early identification and intervention lead to better outcomes; however, only a minority are identified before school entry. Primary care is an important setting for identification of developmental and behavioral conditions as most young children attend well-child visits regularly and parents expect developmental guidance from pediatricians. Two key pediatric preventive services are recommended: developmental monitoring/surveillance at every well-child visit and developmental screening at 9 months, 18 months, …

Of Rats And Men, Thomas S. Walsh

Capstones

This capstone is a data-driven investigation into New York City's rat problem. By using publicly available government data to map rat activity in NYC, I identified several socio-economic variables that correlate with rat populations at the community district, borough, and city-scale. I used these findings (mainly that rat problems are linked to lower incomes) as the basis of an investigation, which includes interviews with residents, experts, and city officials. Prof. Bobby Corrigan, urban rodentologist and formerly with the NYC Department of Health criticizes the city's efforts for the first time on the record.

https://thomasseiyawalsh.wixsite.com/ratstone

Mental Hell, Jesenia De Moya, Hanaa' Tameez, Maritza Villela

Capstones

Mental Hell explores how difficult it is for low-income Latinos in New York City to access mental health care. Through explanations from experts and the personal stories of three Latinas New Yorkers who have gone through the process of trying to get the care they need, the story guides the reader through the many roadblocks this demographic encounters specifically under the insurance of Medicaid.

This is an extremely important topic that affects many New Yorkers, and we believe something needs to be done to make this type of healthcare more accessible for Latinos. New York City has a very high …

Nonprofit Hospital Community Benefit Requirements: An Exploration Of National Health Policy Models, Justin P. Swearingen

Dissertations and Theses

Introduction: Nonprofit hospital organizations are public charities with complete tax immunity. Such exemptions are worth $24.6 billion and impact the health of hundreds of millions of people, yet what these charities must do to meet the current “community benefit standard” to maintain their tax-exempt status remains a policy debate. To help inform policymaking, an evaluation of four national requirement models was performed: Tax Value Requirement (at least the value of the tax exemptions must be spent on community benefit), Grassley Requirement (at least 5% of revenue must be spent on community benefit), Expense Requirement (at least 3% of expenses must …

The Long-Term Consequences Of Child Abuse And Neglect In Men, Robert A. Beattey Jr.

Dissertations, Theses, and Capstone Projects

Research indicates that the annual incidence of child maltreatment is around 10% and that more than one-quarter of children have, at least indirectly, experienced some form of violence. Prospective studies find that in high-income countries, like the United States, there are moderate correlations between childhood maltreatment and low educational achievement, low skilled employment, depression, suicide attempts, and alcohol problems, as well as strong correlations with obesity, behavior problems in childhood and adolescence, and criminal behavior. Despite the high costs of child abuse and neglect—both direct and indirect—and decades of research and public health, justice, and social service investment in prevention …

The Effect Of Paid Sick Leave On Physician Office-Based Visits, Korvin Vicente

Theses and Dissertations

This paper uses a balanced sample of workers from cross-sections of the National Health Interview Survey to estimate the causal effects of paid sick leave on the medical care seeking behavior of individuals, as measured by physician office-based visits.

Overpopulation And The Impact On The Environment, Doris Baus

Dissertations, Theses, and Capstone Projects

In this research paper, the main focus is on the issue of overpopulation and its impact on the environment. The growing size of the global population is not an issue that appeared within the past couple of decades, but its origins come from the prehistoric time and extend to the very present day. Throughout the history, acknowledged scientists introduced the concept of “overpopulation” and predicted the future consequences if the world follows the same behavioral pattern. According to predictions, scientists invented the birth control pill and set population control through eugenics. Despite that, population continued to increase and fight with …

Fresh Air: The Impact Of Reformulated Gasoline On Infant Health, Mohammed Husain

Theses and Dissertations

This paper considers a 1996 Reformulated Gasoline program, where gasoline emissions were regulated in California, to observe the effects on infant health indicators. I use a cross-county analysis to find significant effects from the policy that suggests an improvement in birth weight, gestational length, and infant mortality.

The Effect Of Health Insurance On Young Adults' Labor Market Outcomes: Evidence From The Affordable Care Act's Dependent Coverage Expansion, Quazi Hassan

Theses and Dissertations

The Affordable Care Act’s dependent coverage mandate extended young adults’ parental coverage to age 26. I study the expansion’s impact on young adults’ labor market outcomes using a control function method. Following the expansion, I find dependent coverage lowered labor force participation, lowered incomes, and mixed evidence regarding labor supply.

Shepherds, Wolves And Lizards: Exploring The Truck Stop Sex Trade During The Last Days Of The American Trucker, Joshua Keefe

Capstones

This is a longform piece on the sex trade at American truck stops.

https://app-social.shorthand.com/preview/gYMjJD4CpenyTqnbro2mTn2nEjbD5Cme3CtEjbr4yze3gKM3Wr7gv6nCOEnJH5gv

The South African Elderly: Neglect, Social Contribution And The Hiv/Aids Epidemic, Alessia Frisoli

Dissertations, Theses, and Capstone Projects

With a slowing fertility rate and an increasing longevity, the world population is aging. Both developed and developing countries have seen their elderly become more numerous with an increasing burden on their financial, medical and social system. Many scholars have suggested immediate change of policies to contain the predicted crisis that will affect the health care and the pension schemes in the next decades. However, few have investigated the positive role that the seniors play contributing to society, beyond the complications caused to the economy and welfare system. This thesis will support the argument that the elderly, if appropriately cared …