Health Policy Commons^™

Essays On Health And Immigration Policy, Selen Ozdogan

Dissertations, Theses, and Capstone Projects

This dissertation consists of two essays in applied microeconomics, each examining how individuals and institutions respond to policy changes. Both essays leverage natural experiments and recent advances in difference-in-differences estimation to identify causal effects. Both also speak to a common theme in public policy: the gap between intended and actual consequences of government intervention, and the role that policy design plays in shaping those consequences.

The first essay examines the impact of state-level e-cigarette excise taxes on nicotine and tobacco exposure among adults aged 18 and older. A central contribution is its use of individual-level panel biomarker data from urine …

Editorial: Migration And Health: A Human Rights Perspective - Conference Insights And Beyond, Noemi Rodriguez, Mira Goral, Justine Mcgovern, Allison Squires, María Isabel Roldos

Publications and Research

No abstract provided.

Path Dependency And The Politics Of U.S. Health Reform, Sophia Spadafore

Dissertations, Theses, and Capstone Projects

This study examines the impact of path dependency on health reform efforts in the United States, specifically analyzing how past policy decisions constrain subsequent reform possibilities. Utilizing the theoretical framework of historical institutionalism, the study investigates two significant cases—the passage of Medicare and Medicaid in 1965 and the The Patient Protection and Affordable Care Act (ACA) in 2010—to illustrate how successful healthcare reforms embed institutional arrangements that limit future policy innovation. Through a comparative case study approach grounded in legislative records, historical texts, and scholarly analyses, the research highlights that major healthcare reforms in the U.S. have consistently been structured …

Moving The Needle: The Policy Of Change On Syringe Access, New York City And State, 1988–2023, Joyce Rivera

Dissertations, Theses, and Capstone Projects

By the mid-1980s, the HIV/AIDS epidemic breached a longstanding consensus between the political class and its bureaucratic alliances that had relied for decades on attitudes and orientations that championed punitive prohibition toward drugs as a bedrock principle of policy making. This ‘focusing event’ created an opening for HIV/AIDS activists to build a movement that offered an alternative, a more effective and just approach to how government policies and practices can manage illegal drugs and the persons who use drugs.

The dissertation uses several theoretical and methodological tools to address the central research objective that highlights the critical role played by …

Predictors Of Mental Health Clinic Staff Self-Efficacy In Recognizing And Responding To Suicide Risk, Hannah Ritz

Theses and Dissertations

Staff self-efficacy is critical to suicide prevention, yet its predictors within Zero Suicide initiatives are not well understood. Among 1,038 CCBHC staff, perceived organizational support, response-focused training, and lower suicide myth endorsement most strongly predicted self-efficacy. Clinical role and prior experiences contributed modestly, highlighting multilevel influences on workforce readiness.

Examining Drug Policy In Portugal And Greece, Collin Fernandes

Dissertations and Theses

This thesis examines the divergent drug policies implemented in Portugal and Greece, analyzing why Portugal's comprehensive decriminalization model has been more successful than Greece's partial approach. Since 2001, Portugal has pioneered a drug policy that decriminalizes all drugs for personal use while investing in harm reduction services, rehabilitation, and social reintegration. In contrast, Greece maintained criminalization while implementing more limited harm reduction measures, particularly through OKANA (the Organization Against Drugs). The research highlights how economic factors, particularly the 2008 financial crisis and austerity measures, negatively affected both countries' programs but hit Greece's initiatives with greater severity. Portugal's programs have remained …

Essays In Applied Microeconomics, Ege Aksu

Dissertations, Theses, and Capstone Projects

This dissertation consists of two chapters that investigate the effect of public health policies on health outcomes.

The first chapter evaluates the impact of the extensive health care reforms enacted between 2003–2013 under the Health Transformation Program (HTP) in Turkey on maternal and infant health outcomes for the poor. By focusing on a specific insurance program (Green Card) expansion that was a part of HTP, I explore changes in infant survival, fertility, and children’s vaccination status. Before 2004, all public health insurance beneficiaries (the control group) were covered for outpatient services, including prenatal and postnatal doctor visits, gestational diabetes screenings, …

Could It Be That Healthcare Systems Are Putting Profits Before Patients?, Majida Naz

Publications and Research

The escalating costs of healthcare in the United States have led to a significant burden on diverse populations, often resulting in diminished access to quality care. As profit-driven motives increasingly influence healthcare providers and insurers, the affordability and accessibility of healthcare services are adversely affected. This research examines the intricate dynamics between profit motives and healthcare provision, employing a mixed-methods approach to investigate the impact on the diverse groups. By conducting a quantitative and some qualitative examination of healthcare spending data, this study demonstrates a pronounced disparity in the quality of healthcare services provided to populations across different income levels. …

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.

The Puerto Rico Children Vulnerability Index, 2021, Jennifer Hinojosa, Laura Colon-Melendez, Jorge Soldevilla-Irizarry, Damayra I. Figueroa-Lazu

CUNY Centro, The Center for Puerto Rican Studies

Recent natural hazards and resulting disasters in Puerto Rico have drawn attention to the social vulnerability of children in the archipelago. We created the Child Vulnerability Index (CVI) to identify the scale and patterns of child vulnerability in the archipelago, and provide insights to mitigate the effects that hazardous events may cause. The index was created using 2017-2021 American Community Survey (ACS) data pertaining to three broad themes: Personal characteristics of children, Characteristics of households with children, and Overall household characteristics for all Municipios, Barrios, and Census Tracts in Puerto Rico. The CVI is a two-pronged tool consisting of an …

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 …

The Promise Of Universalism Deferred: Political Economy Of Social Policy In 21st Century Latin America, Juan C. Ferre

Dissertations, Theses, and Capstone Projects

In the first decade and half of the 21st century, most Latin American countries experienced a long-overdue reduction in income inequalities and significant social policy expansion. While this welfare expansion has been widely documented, scholars have paid less attention to the persistent or increasing segmentation: inequalities in transfers and in the quality of services across population groups continued unabated. This dissertation employs mixed-methods to respond to the following questions: have governments in Latin America, and Left governments in particular, made significant progress toward universal social policy?

For 17 Latin American countries in the period 2000-2020, I measure three dimensions …

"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 …

The Relationship Between The National Family Caregiver Support Program (Nfcsp) And Help Received By The Elder Population, Symone Biggerstaff

Theses and Dissertations

The rising elder American population is causing an increased demand for elder support. Elder support often comes from informal caregivers. There are economic implications of elder care, such as increased government funding for elder care facilities and economic strain on caregivers and care recipients. The National Caregiver Support Program (NFCSP) was the first federal program, implemented in 2000 under the Older Americans Act re-authorization, designed to unburden caregivers. This paper aims to analyze the connection between NFCSP eligibility and the aid provided to elderly care recipients with ADL and IADL challenges. Using Health and Retirement Study (HRS) data and a …

Coh 1700: Health Care Coordination Syllabus, Sasha Harry

Open Educational Resources

This is the syllabus for a Health Care Coordination course.

The goal of health care coordination is to improve patient outcomes with better health care services. Care coordinators play a critical role in improving patient care. Students will learn how to effectively advocate for patients and interact with members of the healthcare team in finding solutions to provide high quality, value-based, and efficient care. Effective communication styles, assessing patient’s needs and goals, and helping with patients’ transitions of care are among many topics covered in this course. Upon course completion, students will have acquired basic knowledge and skills to educate, …

Toward Informatics-Enabled Preparedness For Natural Hazards To Minimize Health Impacts Of Climate Change, Jimmy Phuong, Naomi O. Riches, Luca Calzoni, Gora Datta, Deborah Duran, Asiyah Yu Lin, Ramesh P. Singh, Anthony E. Solomonides, Noreen Y. Whysel, Ramakanth Kavuluru

Publications and Research

Natural hazards (NHs) associated with climate change have been increasing in frequency and intensity. These acute events impact humans both directly and through their effects on social and environmental determinants of health. Rather than relying on a fully reactive incident response disposition, it is crucial to ramp up preparedness initiatives for worsening case scenarios. In this perspective, we review the landscape of NH effects for human health and explore the potential of health informatics to address associated challenges, specifically from a preparedness angle. We outline important components in a health informatics agenda for hazard preparedness involving hazard-disease associations, social determinants …

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 …

Factors Associated With Mask Use In New York City Neighborhood Parks During The Covid-19 Pandemic: A Field Audit Study, Lisa Hitch, Marie A. Sillice, Hanish Kodali, Katarzyna E. Wyka, Javier Otero Peña, Terry Tk Huang

Publications and Research

Background: Mask use is a cost-effective measure to decrease COVID-19 transmission. Mask mandates intend to increase mask compliance but are often ambiguous when it comes to public outdoor spaces.

Methods: We used a field audit study to examine mask use in New York City neighborhood parks during COVID-19. 1453 park visitors were observed in 13 parks during July–August 2020 using a modified and validated park use audit tool (System for Observing Play and Recreation in Communities) that included items on general and proper mask use (i.e., mask covering both nose and mouth). Generalized estimating equation regression was used to determine …

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 …

The Case For Public Investment In Higher Pay For New York State Home Care Workers: Estimated Costs And Savings, Isaac Jabola-Carolus, Stephanie Luce, Ruth Milkman

Publications and Research

This report explores one potential solution to the mounting home care labor shortage in New York State: substantially raising wages for the state's home care workers. The analysis presents detailed projections, based on the best available data, of the economic effects of such an intervention, estimating the costs and benefits that would result. We find that public funding to raise home care wages would require significant resources, but those costs would be surpassed by the resulting savings, tax revenues, and economic spillover effects. The net economic gain would total at least $3.7 billion. Lifting wages would also help fill nearly …

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 …

Framing Inclusion: The Media Treatment Of Irregular Immigrants' Right To Health Care In Spain, Alisa Petroff, Anahí Viladrich, Sònia Parella

Publications and Research

With the passing of Royal Decree-Law 16/2012, Spain’s national health system switched from a model defined by universal and free health care principles, to a private insurance system that excluded large population groups. Based on a qualitative research design, this paper examines the media treatment of undocumented immigrants’ prerogatives to public health care in Spain (2012–2018). The analysis of 234 articles, drawn from three major Spanish newspapers, reveals three frames that underscore the media’s "rhetorics of inclusion," which argue for the extension of free medical services to irregular immigrants a topic traditionally underestimated by the literature. The moralist frame, supported …

Hs-4100 - Global Health Issues, Jose Nanin

Open Educational Resources

This syllabus includes OER materials and college policies for a fully online course that takes a comprehensive look at global health issues. In this course, the assessment of health issues are analyzed from various perspectives including geographic, ethnic, religious, human rights, socioeconomic, social, cultural, and political influences. Students learn about global environmental causes and consequences of infectious diseases, major diseases, mental illness, natural disasters, malnutrition, drug and alcohol addiction, violence and injuries.

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 …

Covid-19’S Effects On New York City’S Food System: Lessons For Public Health Responses, Nevin Cohen, Nicholas Freudenberg

Publications and Research

The COVID-19 pandemic disrupted food availability and affordability and changed the daily food practices of New Yorkers. Eleven surveys of samples of 1,000 New York City adults from March 13 through June 28 illustrate three effects on food access and food insecurity: (1) closing restaurants, schools, and other sources of prepared foods reduced access and changed shopping patterns, food expenditures, and diets; (2) economic disruption exacerbated food insecurity and increased demand for food assistance; and (3) altered food practices affected diets and health. These impacts were disproportionately borne by vulnerable populations. This paper reports survey responses illustrating the effects of …

High Tech, High Risk: Tech Ethics Lessons For The Covid-19 Pandemic Response, Emanuel Moss, Jacob Metcalf

Publications and Research

The COVID-19 pandemic has, in a matter of a few short months, drastically reshaped society around the world. Because of the growing perception of machine learning as a technology capable of addressing large problems at scale, machine learning applications have been seen as desirable interventions in mitigating the risks of the pandemic disease. However, machine learning, like many tools of technocratic governance, is deeply implicated in the social production and distribution of risk and the role of machine learning in the production of risk must be considered as engineers and other technologists develop tools for the current crisis. This paper …