Health Policy Commons^™

Association Of Insurance And Provider Type With Patients’ Perceived Cost And Ease Of Access To Healthcare Services Among Medicare Beneficiaries Diagnosed With Diabetes, Metria Harris

Theses and Dissertations

Medicare beneficiaries diagnosed with diabetes are likely to have health complications or episodes associated with diabetes, resulting in higher health care utilization and costs. Andersen’s Health Care Utilization Behavior Model (HCBM) includes predisposing, enabling, and need factors, but it excludes perception. Ajzen’s Theory of Planned Behavior (TPB) shows that perception influences health service use. This study was performed using a real-world model integrating Andersen’s HCBM and Ajzen’s TPB to determine whether there was an association between insurance type (Medicare Part D versus non-Part D) and perceived ease of access or cost among Medicare beneficiaries with diabetes. The second objective was …

Introduction Of Innovative Medical Practices In Mayo Clinic: Effect Of The Interventions On Patient Outcomes, Duaa I. Aljabri

Theses and Dissertations

Purpose: Assessment of health technologies in medical practice is an ongoing process to provide clinicians and policymakers with information on the value of those applications. This dissertation aims to add to the existing body of literature and fill the gaps in prior studies by assessing two health technologies in Mayo Clinic Florida (MCF). The first paper provides an assessment of patient portal adoption and activity during hospitalization among cancer patients, and determines whether a portal application is associated with selected indices of patient safety, utilization and satisfaction. The second paper provides an assessment of a new approach in pain …

Spillover Theory: Unintended Consequences Of Provisions In The Affordable Care Act, Robert T. Braun

Theses and Dissertations

Objective: To examine spillovers from a federal policy, managed care market, and community perspective.

Data Sources/Study Setting: We studied spillovers from a federal policy and managed care market perspective using the Health Care Utilization Project’s (HCUP) State Inpatient Database (SID). American Hospital Association (AHA) data, Interstudy Commercial Managed Care, and Area Health Resource File (AHRF). Medicare Advantage county-level payment schedules originate from CMS. We examined community uninsurance spillovers using 2011-2015 Medical Expenditure Panel Survey (MEPS), the Area Health Resource File (AHRF), and the Small Area Health Insurance Estimator (SAHIE).

Study Design: Ordinary Least Squares (OLS) and difference-in-difference regression analyses were …

How Do Health System Employees With Established Musculoskeletal Complaints Decide On Their Treatment Pathway? A Qualitative Approach, Noor Alshareef

Theses and Dissertations

Purpose: Non-pharmacologic treatment such as physical therapy (PT) are advocated for musculoskeletal pain for decreasing opioid use. Early access to PT has been shown to decrease costs and improve outcomes through direct access via self-referral. Although self-referral to PT is permitted in the majority of U.S states, health insurance coverage has been identified as a barrier preventing some patients with musculoskeletal complaints from using it. There are few studies examining patient factors related to early access to physical therapy via self-referral. The purpose of this study was to identify the factors outside of insurance that influence the choice to access …

A Study On Satisfaction Of Dental Implant Patients, Jung Su O

Theses and Dissertations

The implant has been around for half a century. It started in Sweden in the 1960s and is now being actively practiced all over the world. It is important to investigate what constitutes a standard for a consumer of medical services in selecting a dentist to receive implants. A great number of dentists and research organizations have published research papers on theory and techniques of implants as well as their strengths and weaknesses. However, researches on reality and satisfaction rate of patients are still very rare.

The purpose of this study was to identify how to improve satisfaction of patients …

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.

Economic Burden Of Tuberculosis Among Bangladeshi Population And Economic Evaluation Of The Current Approaches Of Tuberculosis Control In Bangladesh, Mohammad Rifat Haider

Theses and Dissertations

Introduction: Tuberculosis (TB) is major scourge for human history and causes profound economic burden. Bangladesh is a high burden TB country with 12% of its annual death is caused and 362 thousand people are infected by TB. DS-TB is the most prominent type of TB found in Bangladesh and a 6 month drug regimen (2 month intensive and 4 month continuation phase) is followed. But the directly observed treatment short-course (DOTS) differ in delivery through community health workers (CHW) and community members (CM). Bangladesh has also experienced surge in the number of MDR-TB cases with a 29% of MDR-TB cases …

Depressive Symptoms Association With Health Outcomes And Treatment In Older Americans With Diabetes, Lashonda Jovon Williams

Theses and Dissertations

Introduction: Diabetes remains the 7th leading cause of death in the United States. Diabetes is a major public health concern of its own, but when you add the comorbidity of depression, diabetes outcomes are amplified. This dissertation examines how depressive symptomatology and treatment for depression are associated with selfreported health (SRH) and diabetes control.

Methods: Chi-square and logistic regression were used to analyze data from the Health and Retirement Study (2012). We assessed the associations between SRH and diabetes control with depressive symptomatology data.

Results: In our sample (n=4374), 19% of respondents reported high depressive symptomatology and …

Feasibility Of Introducing Investor-Owned Hospitals In Korea, Hongseok Seo

Theses and Dissertations

Since 2002, there has been active debate regarding the introduction of for-profit hospitals in South Korea: the advocates highlight the multiplication of economic value after the introduction of for-profit hospitals, whereas the opponents voice their concern about the possible negative consequences for-profit entities can create within the health care system. Various stakeholders including doctors’ associations, hospital associations, and civic groups have been for or against the introduction of for-profit hospitals, according to their interests. The government has tried to develop the national health and medicine system based on the positive and negative impacts of their introduction. In December, 2015, the …

Association Between Job Satisfaction And Pay: The Case Of The Wage Payment System Of Dental Clinics In Korea, Eui Jeong Kim

Theses and Dissertations

The purpose of this study is to investigate empirical type of the wage structures and the sub-items of wage applied at dental clinics and to analyze the determinants of pay satisfaction of dental employees. The questionnaire used in this study consists of personal characteristics, characteristics of workplace, administration of pay, Pay Satisfaction Questionnaire (PSQ), Job Descriptive Index (JDI). PSQ and JDI were translated, and backward translation into Korean was implemented. A pilot test was conducted with 25 dental employees to complete the questionnaire. Survey was conducted from February to July in 2015, receiving 302 valid responses. ANOVA or t-test was …

Racial And Ethnic Differences In Receipt Of Immediate Breast Reconstruction Surgery: Do Hospital Characteristics Matter?, Jaya Shankar Khushalani

Theses and Dissertations

Immediate Breast Reconstruction Surgery (IBRS) is associated with better quality of life among women who undergo a mastectomy. Despite insurance coverage for IBRS, utilization of IBRS remains low. Data from publicly available sources for 2010-2012 are used to examine the association between hospital characteristics receipt of IBRS by patients. Minority-serving status, low bed size, for-profit ownership, non-teaching status, high competition, low density of plastic surgeons in the market and non-metropolitan location are associated with lower likelihood of receipt of IBRS.

Racial and ethnic minorities are less likely to receive IBRS. A mixed effects logistic regression model with interactions between Black/Hispanic …

Association Of Provider Communication And Inpatient Hospital Readmissions, Jeremy Dean Faulkenburg

Theses and Dissertations

Introduction: Inpatient hospital readmission rates represent an important clinical and economic problem. Clinical interventions have shown significant decreases in preventable readmissions, but are costly to implement. Another approach is to better equip patients with the knowledge and resources to manage their care after discharge. Patients receive instruction from both nurses and physicians, as well as information pertaining to post-discharge care and instructions for care while at home. This study examines the association between provider communication and inpatient hospital readmissions.

Methods: This study used survey data from the 2013 and 2014 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The …

Affordability, Utilization And Satisfaction With Care: A Policy Context For Improving Health Care Experiences, Anushree M. Vichare

Theses and Dissertations

Disparate healthcare experiences continue to pose a challenge; vulnerable populations such as low-income and racial and ethnic minorities may not be able to afford or utilize care when needed or receive quality care. The sources of disparities are complex and multi-factorial, which include health care system-level factors such as insurance and health care workforce. It is relatively less known to what extent these contribute to disparities related to a patient’s overall health care experience across three important domains – affordability, utilization and satisfaction with care.

This dissertation has three objectives. First, to assess how insurance benefit design affects health care …

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.

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.

Examining The Relationship Among Patient-Centered Communication, Patient Engagement, And Patient’S Perception Of Quality Of Care In The General U.S. Adult Population, Jumee Wang

Theses and Dissertations

Introduction: Patient-centered care is a major focus of healthcare organizations, policy makers, and researchers. Patient-centered communication by the provider and patient engagement are important components of patient-centered care. Despite increasing attention to these topics, we do not fully understand how patient-centered communication and patient engagement relate to perceived quality of care as reported by patients. This study takes some initial steps in exploring these relationships. The study also identifies patient-related factors such as sociodemographic, health-related, and health system factors that are associated with patient-centered communication, patient engagement, and perceived quality of care.

Method: This study used survey data …

Influence Of Public Insurance On Healthcare Access And Cancer Care, Wafa W. Tarazi

Theses and Dissertations

Medicaid expansion under the Affordable Care Act (ACA) facilitates access to care among vulnerable populations, but 21 states have not yet expanded the program. Tennessee’s Medicaid program experienced a dramatic Medicaid contraction when the program disenrolled approximately 170,000 nonelderly adults in 2005. Pre-ACA expansions were associated with better access to and utilization of healthcare services. However, little is known about the effect of these policy changes on improvement in health outcomes for women diagnosed with breast cancer, access to care for cancer survivors, and the effect of generosity and duration of expansion on access to care.

This dissertation has three …

Implementation Of Self-Directed Supports For Individuals With Intellectual And Developmental Disabilities: A Political Economy Analysis, Matthew P. Decarlo

Theses and Dissertations

Self-directed supports, as a method of service delivery, have grown from small pilot programs in a handful of states to at least one program in every state. For individuals with intellectual and developmental disabilities (IDD), self-direction presents unique opportunities to engage in self-determined behavior and shape the services upon which they rely. Although the evidence base for self-direction is relatively robust, there is a significant lack of information on how implementation of self-direction is faring on the national level. The purpose of this study is to understand how the political and economic factors within and across states have impacted the …

Healthcare Utilization And Expenditure Patterns Among Older Adults With Functional And Medical Decline, Ashley Shields Robertson

Theses and Dissertations

Purpose. As the aged population of this country grows, the U.S. healthcare system will face increased pressure to provide long-term care services and supports to increasing numbers of elderly Medicare beneficiaries. Studies have indicated that unmet long-term care need can lead to increased, unnecessary utilization of the healthcare system, thus further taxing the Medicare system. Little is known about how type of long-term care, as well as how long-term care policies—specifically payment policies—affect health care utilization. The objective of this original dissertation research was to examine the effects of place of residence (community versus residential long-term care facility) and …