Health Policy Commons^™

Medical Education Departments: A Study Of Four Medical Schools In Sub-Saharan Africa, Elsie Kiguli-Malwadde, Zohray Talib, Hannah Wohltjen, Susan C. Connors, Jonathan Gandari, Sekelani S. Benda, Lauren A. Maggio, Susan C. Van Schalkwyk

Health Policy and Management Faculty Publications

Background

Many African countries are investing in medical education to address significant health care workforce shortages and ultimately improve health care. Increasingly, training institutions are establishing medical education departments as part of this investment. This article describes the status of four such departments at sub-Saharan African medical schools supported by the Medical Education Partnership Initiative (MEPI). This article will provide information about the role of these institutional structures in fostering the development of medical education within the African context and highlight factors that enable or constrain their establishment and sustainability.

Methods

In-depth interviews were conducted with the heads or directors …

Revising The International Health Regulations: Call For A 2017 Review Conference., Rebecca Katz, Scott F. Dowell

Health Policy and Management Faculty Publications

No abstract provided.

Alternate Payment Models For Ryan White Hiv/Aids Program Funded Services: Strategies Used By Nine Grantees, Naomi Seiler, Scott Dafflitto, Rosalind Fennell, Julia Hidalgo, Katie Horton, Mary-Beth Malcarney

Health Policy and Management Faculty Publications

The Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB) offers Ryan White HIV/AIDS Program (RWHAP) Part A and Part B grantees some flexibility in determining the method used for paying subgrantees for core medical and support services. Many Part A and Part B grantees use a traditional “cost-based reimbursement” approach, in which subgrantees submit budgets that include personnel costs, other direct costs related to the provision of funded services, and capped indirect costs (IDCs). Some grantees, however, have developed alternative reimbursement models for core medical and/or support services. This report summarizes the reimbursement approaches taken by nine RWHAP grantees. …

Undergraduate Public Health Education: Is There An Ideal Curriculum?, Leonard H. Friedman, Joel M. Lee

Health Policy and Management Faculty Publications

No abstract provided.

Evaluation Of Social Media Utilization By Latino Adolescents: Implications For Mobile Health Interventions, Megan Landry, Amita Vyas, Monique Turner, Sara Nelson Glick, Susan Wood

Health Policy and Management Faculty Publications

Background: Trends in social media use, including sending/receiving short message service (SMS) and social networking, are constantly changing, yet little is known about adolescent’s utilization and behaviors. This longitudinal study examines social media utilization among Latino youths, and differences by sex and acculturation.

Objectives: The purpose of this study was to examine Latino adolescents’ social media utilization and behavior over a 16-month period, and to assess whether changes in use differed by sex and acculturation.

Methods: This study included 555 Latino youths aged 13-19 who completed baseline and 16-month follow-up surveys. Prevalence of social media utilization and frequency, by sex …

Mapping Of Networks To Detect Priority Zoonoses In Jordan, Erin M. Sorrell, Mohammad El Azhari, Nezar Maswdeh, Sarah Kornblet, Claire J. Standley, Rebecca L. Katz, Ibrahim Ablan, Julie E. Fischer

Health Policy and Management Faculty Publications

Early detection of emerging disease events is a priority focus area for cooperative bioengagement programs. Communication and coordination among national disease surveillance and response networks are essential for timely detection and control of a public health event. Although systematic information sharing between the human and animal health sectors can help stakeholders detect and respond to zoonotic diseases rapidly, resource constraints and other barriers often prevent efficient cross-sector reporting. The purpose of this research project was to map the laboratory and surveillance networks currently in place for detecting and reporting priority zoonotic diseases in Jordan in order to identify the nodes …

Comparing Cost-Effectiveness Of Hiv Testing Strategies: Targeted And Routine Testing In Washington, Dc., Amanda D Castel, Sungwoog Choi, Avi Dor, Jennifer Skillicorn, James Peterson, Nestor Rocha, Michael Kharfen

Health Policy and Management Faculty Publications

BACKGROUND: Routine HIV testing is an essential approach to identifying undiagnosed infections, linking people to care and treatment, and preventing new infections. In Washington, DC, where HIV prevalence is 2.4%, a combination of routine and targeted testing approaches has been implemented since 2006.

METHODS: We sought to evaluate the cost effectiveness of the District of Columbia (DC) Department of Health's routine and targeted HIV testing implementation strategies. We collected HIV testing data from 3 types of DC Department of Health-funded testing sites (clinics, hospitals, and community-based organizations); collected testing and labor costs; and calculated effectiveness measures including cost per new …

Clash Of The Titans: Medicaid Meets Private Health Insurance, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Throughout its first forty-eight years of life, the federal Medicaid statute lacked a viable insurance pathway for most low-income adults' ineligible for employer-sponsored coverage. In what is arguably the most important public health achievement since the enactment of Medicare and Medicaid fifty years ago, the Patient Protection and Affordable Care Act (ACA) fundamentally alters this picture. Building on earlier breakthroughs for children, the ACA restructures Medicaid to cover poor adults and juxtaposes its new architecture against an affordable and accessible private insurance market for people ineligible for employer-sponsored or government insurance.

Impact Of Health Insurance Expansions On Nonelderly Adults With Hypertension., Suhui Li, Brian K. Bruen, Paula M. Lantz, David Mendez

Health Policy and Management Faculty Publications

Introduction

Hypertension is a risk factor for cardiovascular disease (CVD), the leading cause of death in the United States. The treatment and control of hypertension is inadequate, especially among patients without health insurance coverage. The Affordable Care Act offered an opportunity to improve hypertension management by increasing the number of people covered by insurance. This study predicts the long-term effects of improved hypertension treatment rates due to insurance expansions on the prevalence and mortality rates of CVD of nonelderly Americans with hypertension.

Methods

We developed a state-transition model to simulate the lifetime health events of the population aged 25 to …

The Core Competencies For Mental, Neurological, And Substance Use Disorder Care In Sub-Saharan Africa, Pamela Y. Collins, Seggane Musisi, Seble Frehywot, Vikram Patel

Health Policy and Management Faculty Publications

The 2010 Global Burden of Disease Study points to a changing landscape in which non-communicable diseases, such as mental, neurological, and substance use (MNS) disorders, account for an increasing proportion of premature mortality and disability globally. Despite evidence of the need for care, a remarkable deficit of providers for MNS disorder service delivery persists in sub-Saharan Africa. This critical workforce can be developed from a range of non-specialist and specialist health workers who have access to evidence-based interventions, whose roles, and the associated tasks, are articulated and clearly delineated, and who are equipped to master and maintain the competencies associated …

Should We Put Our Feet In The Water? Use Of A Survey To Assess Recreational Exposures To Contaminants In The Anacostia River., Rianna Murray, Sacoby Wilson, Laura Dalemarre, Victoria Chanse, Janet Phoenix, Lori Baranoff

Health Policy and Management Faculty Publications

The Anacostia River, a tributary of the Potomac River that flows into the Chesapeake Bay, is highly contaminated with raw sewage, heavy metals, oil and grease, trash, pathogens, excessive sediments, and organic chemicals. Despite this contamination, recreation on the river is very popular, including kayaking, canoeing, rowing, and sport fishing. There is currently no information available on the potential health risks faced by recreational users from exposure to the river’s pollutants. A total of 197 recreational users of the Anacostia River were surveyed regarding general demographic information and their recreational behavior over the previous year, including frequency and duration of …

Health Care Access Dimensions And Cervical Cancer Screening In South Africa: Analysis Of The World Health Survey., Tomi F. Akinyemiju, Jasmine A. Mcdonald, Paula M. Lantz

Health Policy and Management Faculty Publications

Background

Cervical cancer is the most commonly diagnosed cancer and the leading cause of cancer mortality among women in sub-Saharan Africa. Recent recommendations for cervical cancer primary prevention highlight HPV vaccination, and secondary prevention through screening. However, few studies have examined the different dimensions of health care access, and how these may influence screening behavior, especially in the context of clinical preventive services.

Methods

Using the 2003 South Africa World Health Survey, we determined the prevalence of cervical cancer screening with pelvic examinations and/or pap smears among women ages 18 years and older. We also examined the association between multiple …

Transforming Health Professions' Education Through In-Country Collaboration: Examining The Consortia Among African Medical Schools Catalyzed By The Medical Education Partnership Initiative., Zohray M. Talib, Elsie Kiguli-Malwadde, Hannah Wohltjen, Miliard Derbew, Yakub Mulla, David Olaleye, Nelson Sewankambo

Health Policy and Management Faculty Publications

BACKGROUND: African medical schools have historically turned to northern partners for technical assistance and resources to strengthen their education and research programmes. In 2010, this paradigm shifted when the United States Government brought forward unprecedented resources to support African medical schools. The grant, entitled the Medical Education Partnership Initiative (MEPI) triggered a number of south-south collaborations between medical schools in Africa. This paper examines the goals of these partnerships and their impact on medical education and health workforce planning.

METHODS: Semi-structured interviews were conducted with the Principal Investigators of the first four MEPI programmes that formed an in-country consortium. These …

Addressing Medicaid/Marketplace Churn Through Multimarket Plans: Assessing The Current State Of Play, Sara Rosenbaum

Health Policy and Management Faculty Publications

No abstract provided.

The Population Genetic Structure Of Biomphalaria Choanomphala In Lake Victoria, East Africa: Implications For Schistosomiasis Transmission, Claire J. Standley, Sara L. Goodacre, Christopher M. Wade, J. Russell Stothard

Health Policy and Management Faculty Publications

Background

The freshwater snail Biomphalaria acts as the intermediate host of Schistosoma mansoni, a globally important human parasite. Understanding the population structure of intermediate host species can elucidate transmission dynamics and assist in developing appropriate control methods.

Methods

We examined levels of population genetic structure and diversity in 29 populations of Biomphalaria choanomphala collected around the shoreline of Lake Victoria in Uganda, Kenya and Tanzania, where S. mansoni is hyper-endemic. Molecular markers were utilized to estimate the degree to which snail populations are genetically differentiated from one another.

Results

High levels of snail genetic diversity were found coupled with …

Provision Of Telemedicine Services By Community Health Centers, Peter Shin, Jessica Sharac, Feygele Jacobs

Health Policy and Management Faculty Publications

The objective of this study was to assess the use of telemedicine services at community health centers. A national survey was distributed to all federally qualified health centers to gather data on their use of health information technology, including telemedicine services. Over a third of responding health centers (37%) provided some type of telemedicine service while 63% provided no telemedicine services. A further analysis that employed ANOVA and chi-square tests to assess differences by the provision of telemedicine services (provided no telemedicine services, provided one telemedicine service, and provided two or more telemedicine services) found that the groups differed by …

Children's Use Of Dental Care In Medicaid: Federal Fiscal Years 2000-2012, Erika Steinmetz, Brian K. Bruen, Leighton C. Ku

Health Policy and Management Faculty Publications

This report presents with national and state-specific analyses about dental services received by children ages 1 to 20 under Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit in federal fiscal years (FFY) 2000-2012. These analyses are based on data reported by state Medicaid agencies using Form CMS-416 (Form 416); all data reflect updates received by CMS as of April 3, 2014. This report focuses on the number of children who received any dental service, any preventive dental service (e.g., dental cleaning or application of dental sealants) and any dental treatment service (e.g., filling a cavity). The national trend …

Access To Comprehensive Perinatal Services Among Pregnant Women Enrolled In Both Medi-Cal And Covered California: Aligning And Integrating Care, Sara J. Rosenbaum, Carla Hurt, Mark Dorley, Sara Rothenberg, Nancy Lopez

Health Policy and Management Faculty Publications

Medi-Cal-enrolled women who are pregnant are entitled to coverage for enriched pregnancy-related care under Medi-Cal’s Comprehensive Perinatal Services Program (CPSP), a national landmark in the care and management of pregnant women with elevated health risks due to their low economic status. This entitlement applies to all pregnant women enrolled in Medi-Cal, including women who also are enrolled in subsidized health plans purchased through Covered California. The task that jointly faces Medi-Cal and Covered California is how best to align these two sources of pregnancy care financing in order to achieve a central goal of SB 857 – ensuring that dually …

Process Evaluation Outcomes From A Global Child Obesity Prevention Intervention, Simone Pettigrew, Jean Michel Borys, Hugues Ruault Du Plessis, Lea Walter, Terry T.K. Huang, Jeffrey Levi, Jan Vinck

Health Policy and Management Faculty Publications

Background

While it is acknowledged that child obesity interventions should cover multiple ecological levels (downstream, midstream and upstream) to maximize their effectiveness, there is a lack of evaluation data to guide the development and implementation of such efforts. To commence addressing this knowledge gap, the present study provides process evaluation data relating to the experiences of groups implementing the EPODE approach to child obesity prevention in various locations around the world. The aim of this exploratory study was to investigate the barriers and facilitators to program implementation in program sites around the world to assist in developing strategies to enhance …

The Impact Of School-Connected Behavioral And Emotional Health Interventions On Student Academic Performance, Olga Acosta Price, M. Biehl, C. Solomon, M. Weir

Health Policy and Management Faculty Publications

This annotated bibliography provides a systematic review of current literature published between 2001 and 2013 and summarizes findings on the relationship between prevention-focused behavioral health interventions, such as social and emotional (SEL) learning programs, and their impact on academic outcomes.

Moving Ahead On The Global Health Security Agenda, Tom Inglesby, Julie E. Fischer

Health Policy and Management Faculty Publications

No abstract provided.

Implications Of The Affordable Care Act's Medicaid Expansion On Low-Income Individuals On Probation, Marsha Regenstein, Lea Nolan

Health Policy and Management Faculty Publications

Every year, millions of Americans become involved in the local criminal justice system and are held in jails, placed on probation, or some combination of the two. This paper focuses on the probation population, a group of individuals who receive correctional supervision in communities, generally as an alternative to incarceration. Individuals on probation are disproportionately low-income and uninsured; many are likely to qualify for health coverage through state Medicaid expansions and private insurance Marketplaces that are part of the Patient Protection and Affordable Care Act. Opening up access to affordable health insurance coverage for this vulnerable group of individuals is …

Progress In The Articulation Of Undergraduate And Graduate Public Health?, Joel M. Lee, Leonard H. Friedman

Health Policy and Management Faculty Publications

No abstract provided.

Physician Tracking In Sub-Saharan Africa: Current Initiatives And Opportunities, Candice Chen, Sarah Baird, Katumba Ssentongo, Sinit Mehtsun, Emiola Oluwabunmi Olapada-Olaopa, Jim Scott, Nelson Sewankambo, Zohray Talib, Melissa Ward-Peterson, Damien Haile Mariam, Paschalis Rugarabamu

Health Policy and Management Faculty Publications

Background

Physician tracking systems are critical for health workforce planning as well as for activities to ensure quality health care - such as physician regulation, education, and emergency response. However, information on current systems for physician tracking in sub-Saharan Africa is limited. The objective of this study is to provide information on the current state of physician tracking systems in the region, highlighting emerging themes and innovative practices.

Methods

This study included a review of the literature, an online search for physician licensing systems, and a document review of publicly available physician registration forms for sub-Saharan African countries. Primary data …

Medicaid Reimbursement For Naloxone: A Toolkit For Advocates, Naomi Seiler, Katie B. Horton, Mary-Beth Malcarney

Health Policy and Management Faculty Publications

Naloxone is an opioid antagonist drug used to counter the effects of an opiate overdose. It can be administered in medical settings, such as an emergency room, or prescribed as a take‑home medication to be used in case of an emergency. Currently, most types of insurance will cover and reimburse for naloxone administered directly in a medical setting. However, coverage of prescription take‑home naloxone is limited. The Medicaid program provides health insurance for a large and growing number of Americans. Therefore, securing coverage for take‑home naloxone—including costs of counseling/training and for the medicine itself—within Medicaid should be a critical priority …

How The Trans Pacific Partnership Agreement Could Undermine Pharmac And Threaten Access To Affordable Medicines And Health Equity In New Zealand, Deborah Gleeson, Ruth Lopert, Papaarangi Reid

Health Policy and Management Faculty Publications

New Zealand's Pharmaceutical Management Agency (PHARMAC) has been highly successful in facilitating affordable access to medicines through a combination of aggressive price negotiations, innovative procurement mechanisms, and careful evaluation of value for money. Recently the US government, through the establishment of a series of bilateral and plurilateral “free” trade agreements, has attempted to constrain the pharmaceutical access programs of other countries in order to promote the interests of the pharmaceutical industry. The Trans Pacific Partnership Agreement (TPPA) represents the latest example; through the TPPA the US is seeking to eliminate therapeutic reference pricing, introduce appeals processes for pharmaceutical companies to …

Providing Outreach And Enrollment Assistance: Lessons Learned From Community Health Centers In Massachusetts, Julia Paradise, Sara J. Rosenbaum, Peter Shin, Jessica Sharac, Carmen Alvarez, Julia Zur, Leighton C. Ku

Health Policy and Management Faculty Publications

Six years ago, Massachusetts implemented a broad expansion of health coverage to the uninsured population in the state. Understanding that outreach and enrollment assistance would be essential to the success of the expansion, state policymakers provided for public education campaigns, but also for person-to-person, hands-on assistance, especially in communities with large numbers of uninsured people. Community health centers play a central role in this effort. As states and communities gear up to provide outreach and enrollment assistance under the ACA, the experience of the Massachusetts health centers offers lessons that can help inform current efforts to reach and enroll millions …

Racial Disparity In Duration Of Patient Visits To The Emergency Department: Teaching Versus Non-Teaching Hospital, Zeynal Karaca, Herbert S. Wong

Health Policy and Management Faculty Publications

Introduction: The sources of racial disparity in duration of patients’ visits to emergency departments (EDs) have not been documented well enough for policymakers to distinguish patient-related factors from hospital- or area-related factors. This study explores the racial disparity in duration of routine visits to EDs at teaching and non-teaching hospitals.

Methods: We performed retrospective data analyses and multivariate regression analyses to investigate the racial disparity in duration of routine ED visits at teaching and non-teaching hospitals. The Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) were used in the analyses. The data include 4.3 million routine ED …

Racial Disparities In The Use Of Cardiac Revascularization: Does Local Hospital Capacity Matter?, Suhui Li, Arnold Chen, Holly Mead

Health Policy and Management Faculty Publications

Objective

To assess the extent to which the observed racial disparities in cardiac revascularization use can be explained by the variation across counties where patients live, and how the within-county racial disparities is associated with the local hospital capacity.

Data Sources

Administrative data from Pennsylvania Health Care Cost Containment Council (PHC4) between 1995 and 2006.

Study Design

The study sample included 207,570 Medicare patients admitted to hospital for acute myocardial infarction (AMI). We identified the use of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) procedures within three months after the patient’s initial admission for AMI. Multi-level hierarchical …

Triglyceride/Hdl Ratio As A Screening Tool For Predicting Success At Reducing Anti-Diabetic Medications Following Weight Loss., Ghanshyam P. S. Shantha, Anita A. Kumar, Scott Kahan, Pavan K. Irukulla, Lawrence J. Cheskin

Health Policy and Management Faculty Publications

Background and Objectives

Intentional weight loss, by reducing insulin resistance, results in both better glycemic control and decreased need for anti-diabetic medications. However, not everyone who is successful with weight loss is able to reduce anti-diabetic medication use. In this retrospective cohort study, we assessed the predictive accuracy of baseline triglyceride (TGL)/HDL ratio, a marker of insulin resistance, to screen patients for success in reducing anti-diabetic medication use with weight loss.

Methods

Case records of 121 overweight and obese attendees at two outpatient weight management centers were analyzed. The weight loss intervention consisted of a calorie-restricted diet (~1000Kcal/day deficit), a …