Health Policy Commons^™

From Schip Benefit Design To Individual Coverage Decisions, Anne R. Markus, Sara J. Rosenbaum, Ruth E. K. Stein, Jill Joseph

Health Policy and Management Issue Briefs

The majority of states have implemented separate SCHIP (S-SCHIP) programs that significantly depart from Medicaid and resemble less comprehensive commercial products. This difference in program design may result in S-SCHIP potentially being less responsive to children with special needs (CSHCNs). This study explores how responsive insurers are to these higher than average needs. We found that, with one exception, insurers did not agree on the coverage of any specific service, but overall they provided coverage beyond state limits and exclusions. Second, the less acute the childhood condition, the more frequently insurers imposed exclusions. Finally, in the majority of states, some …

Medicaid And Health Information: Current And Emerging Legal Issues, Sara J. Rosenbaum, Patricia Mactaggart, Phyllis Borzi

Health Policy and Management Faculty Publications

Legal questions are an inevitable byproduct of significant technology change in health care such as that underway as a result of health information technology (HIT). This article examines several important existing and emerging legal questions in a Medicaid context. First, do the Centers for Medicare & Medicaid Services (CMS) and State Medicaid agencies, have a fiduciary obligation to adopt and fully use health information technology given its potential to improve health care quality while reducing racial, ethnic, and socioeconomic disparities in health and health care? Second, how can Medicaid privacy standards be reconciled with the Health Insurance Portability and Accountability …

Designing Employer-Sponsored Mental Health Benefits, Rachel Sethi, Joanne Jee, Lisa Chimento, D. Richard Mauery

Health Policy and Management Faculty Publications

No abstract provided.

Land Use And Transportation Planning To Promote Physical Activity In North Carolina, Semra Aytur

Health Management & Policy

With national and state agencies as well as leading public health foundations providing impetus, efforts to improve the understanding of policy and environmental attributes that may support active lifestyles have become a promising area for collaboration between planning and public health professionals. This article highlights the results of work performed at the University of North Carolina at Chapel Hill examining the relationship between planning policies and physical activity and the prevalence of land use policies and implementation tools that might support the viability of non-motorized modes. With the hope of bridging research and practice, it discusses fi ndings most relevant …

The North Carolina Physical Activity Policy Research Center: Making Connections With North Carolina Planners, Kelly R. Evenson, Carrie Fesperman, Semra Aytur, Austin Brown, Daniel A. Rodriguez, David Salveson

Health Management & Policy

Physical activity participation for youth and adults is suboptimal in North Carolina. There is growing interest among policy makers to promote physical activity, yet research in this area is limited. The North Carolina Physical Activity Policy Research Center was established in 2004 to conduct research on physical activity and policy. This cross-disciplinary center brings together faculty and researchers from the University of North Carolina School of Public Health and the College of Arts and Sciences. Current projects include understanding and documenting polices that affect walking and bicycling to school, trail development, and community planning decisions related to physical activity.

Indigenous Healing Practices Among Rural Elderly African Americans, Debra A. Harley

Aboriginal Policy Research Consortium International (APRCi)

Elderly African Americans residing in rural areas have practiced and continue to practice indige- nous healing practices for various reasons. In addition to the belief in the value of such practices, many of these individuals practice indigenous healing because it is cost effective. In this article information is presented on the history of research on indigenous healing practices, theories and models of indigenous healing in the United States, cultural influence, and views of health care providers regarding such practices. This article concludes with a discussion of the relevance of indigenous healing practices across disciplines and approaches, and recommendations of using …

Race, Ethnicity, And Language Of Patients: Hospital Practices Regarding Collection Of Information To Address Disparities In Health Care, Marsha Regenstein, Donna Sickler

Health Policy and Management Faculty Publications

2003 Institute of Medicine (IOM) report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, identified strong evidence of disparities in the health care of racial and ethnic minorities not explained by differences in health insurance coverage and income. Among ways to eliminate these inequalities the IOM report recommended enhanced collection of patient race and ethnicity data. National Public Health and Hospital Institute researchers surveyed 500 non-federal acute care hospitals on their collection of patient race, ethnicity and preferred language information to understand data collection practices in the U.S. hospital industry. The researchers also surveyed 64 safety net hospitals …

A Dose Of Reality: Assessing The Federal Trade Commission/Department Of Justice Report In An Uninsured, Underserved, And Vulnerable Population Context, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Despite the size of their report, the Federal Trade Commission and Department of Justice pay virtually no attention to tens of millions of uninsured and underinsured persons. By focusing on an increasingly rarified group of health care customers—healthy, affluent, and highly insured—the report takes on an untethered quality, with only the slightest tip of the hat to its own limitations. Furthermore, the report overstates the extent of legal constraints on the market, in particular, the degree to which the market is free to select its customers and tailor its goods and services to the best risks. By miscasting the legal …

Reducing Aids-Related Stigma And Discrimination In Indian Hospitals, Vaishali Sharma Mahendra, Laelia Gilborn, Bitra George, Luke Samson, Rupa Mudoi, Sarita Jadav, Indrani Gupta, Shalini Bharat, Celine Daly

HIV and AIDS

People living with HIV/AIDS in India, as elsewhere, face stigma and discrimination in a variety of contexts. Research in India has shown that stigma and discrimination against HIV-positive people and those perceived to be infected are common in hospitals and act as barriers to seeking and receiving critical treatment and care services. Recognizing the need to move beyond documentation of the problem, three New Delhi hospitals; SHARAN, an Indian NGO; and the Horizons program, with support from the National AIDS Control Organisation (NACO), carried out an operations research project to develop and test responses to hospital-based stigma and discrimination against …

Promoting More Gender-Equitable Norms And Behaviors Among Young Men As An Hiv/Aids Prevention Strategy, Julie Pulerwitz, Gary Barker, Marcio Segundo, Marcos Nascimento

HIV and AIDS

The Population Council and the Promundo Institute studied the effectiveness of interventions in Brazil designed to change the attitudes of young men in relation to gender norms and reducing the risk of contracting HIV/STIs. One conclusion of the study was the recognition of the importance of engaging young people (men and women) in the issue of gender relations and the risks of HIV contamination. The results of the study indicate that addressing inequitable gender norms, particularly those that define masculinity, can be an important element of HIV prevention strategies. These findings suggest that group education interventions can successfully influence young …

Abc Messages For Hiv Prevention In Kenya: Clarity And Confusion, Barriers And Facilitators, Julie Pulerwitz, Tiffany Lillie, Louis Apicella, Ann P. Mccauley, Tobey C. Nelson, Simon Ochieng, Peter Mwarogo, Karusa Kiragu, Edward Kunyanga

HIV and AIDS

The Horizons Program and FHI/IMPACT developed a collaborative research study to explore how adults and youth in Kenya define and perceive the ABC (abstinence/being faithful/consistent condom use) terms and behaviors. Additional objectives of the study were to identify attitudes and norms around the ABC behaviors that influence perceptions of them, and the role of important actors in transmitting messages about them. Findings highlight potential challenges in promoting each of the ABC behaviors, as well as some positive elements that can be built upon when developing programs. HIV prevention programs that incorporate ABC messages—both in Kenya and elsewhere—should consider a number …

Examining Adherence And Sexual Behavior Among Patients On Antiretroviral Therapy In India, Avina Sarna, Indrani Gupta, Sanjay Pujari, A.K. Sengar, Rajiv Garg, Ellen Weiss

HIV and AIDS

With increased availability of ART, HIV-positive individuals are living healthier lives and continuing or resuming sexual activity. However, optimism related to ART’s success in slowing disease progression, reducing viral load, and improving health status may lead to more risky sexual practices and a possible increase in transmission of infections. To determining the sexual behavior of HIV-positive persons on ART, the Horizons program, in collaboration with research partners in Delhi and Pune, conducted a study to assess current levels of adherence to ART among a sample of people living with HIV/AIDS, identify the factors that influence their adherence to treatment, and …

Orphans And Vulnerable Youth In Bulawayo, Zimbabwe: An Exploratory Study Of Psychosocial Well-Being And Psychosocial Support, Laelia Gilborn, Louis Apicella, Jonathan Brakarsh, Linda Dube, Kyle Jemison, Mark Kluckow, Tricia Smith, Leslie M. Snider

HIV and AIDS

This Population Council Horizons report presents findings from an exploratory study by the Regional Psychosocial Support Initiative and Catholic Relief Services’ Support to Replicable, Innovative Village/Community-level Efforts Program of vulnerable youth living in and around Bulawayo, Zimbabwe. It describes their demographic characteristics, exposure to stress and trauma, and psychosocial well-being. The report also highlights the relationships between psychosocial well-being outcomes and exposure to stress and trauma, and the differences in psychosocial well-being between males and females, orphaned and nonorphaned youth, and younger and older adolescents. The report concludes with program and research implications.

Exploring Current Practices In Pediatric Arv Rollout And Integration With Early Childhood Programs In South Africa: A Rapid Situation Analysis, Desiree Michaels, Brian Eley, Lewis Ndhlovu, Naomi Rutenberg

HIV and AIDS

This Horizons program report describes the status of pediatric HIV treatment in selected sites in South Africa, identifies gaps in service delivery, and proposes recommendations for strengthening services and expanding children’s access to treatment. The study provides much needed information on critical issues of pediatric HIV care, especially regarding health service and contextual issues surrounding the expansion of access to treatment for HIV-infected children, and key factors that facilitate sustainability of treatment by young children. The aims of the study were to identify successful program strategies in pediatric HIV treatment in South Africa and to determine priority knowledge gaps to …

The Origins Of And Economic Momentum Behind "Pay For Performance" Reimbursement, Rick Mayes

Political Science Faculty Publications

"Pay for performance," a reimbursement method under which some physicians and hospitals are paid more than others for the same services because they have been deemed to deliver better quality care and their patients appear to have better outcomes, is enormously controversial. Disputes invariably arise over how "quality" should (or even can) be measured. Nevertheless, differentiating between medical providers, financially, lies at the heart of this new reimbursement innovation developed by insurance companies and employers. Its two main objectives are: (1) to increase the overall quality of health care that patients receive, and (2) to encourage behavioral change on the …

Pastoral Care In Education, Lydia Hearn, Renee Campbell-Pope, Joanne House, Donna Cross

Research outputs pre 2011

EXECUTIVE SUMMARY

1. During the past decade, there has been growing recognition the school environment plays a major role in the social and emotional competence and wellbeing of children. As a consequence, increasing national and international commitment has been directed towards the development of Health Promoting Schools2, with efforts being made to assess how curriculum and pastoral practice can best contribute to students’ social, emotional, physical and moral wellbeing. Within Australia, the National Safe Schools Framework3 has set as a key priority the importance of achieving a shared vision of physical and emotional safety and wellbeing for all students …

Free To Be Obese In A 'Super Nanny State'?, Nadine Henley

Research outputs pre 2011

Should individuals be free to make lifestyle decisions (such as what, when and how much to eat and how much physical activity to take), without undue interference from the state, even when their decisions may lead to negative consequences (obesity, heart disease, diabetes)?

Snapshot 2006: Maine Workers With Disabilities, Maine’S Commission On Disability And Employment, Choices Ceo Project

Disability & Aging

No abstract provided.

Living Up To Their Name: Profamilia Takes On Gender-Based Violence, Claudia Garcia-Moreno, Rachel E. Goldberg

Poverty, Gender, and Youth

This issue of Quality/Calidad/Qualité describes the evolution of Profamilia through its work on gender-based violence in the Domincan Republic.Their project was conceived along two simultaneous paths: providing support services directly to women and girls who had experienced violence and initiating advocacy in the wider policy arena. Profamilia joined the commission that ultimately designed and promoted a law to increase protection against violence, especially domestic violence against women and children. Although the clinics now run a dynamic service program, the agency has also sustained its advocacy activities. Most of Profamilia’s advocacy work is undertaken in partnership with other NGOs or with …

Priority Setting For Reproductive Health At The District Level In The Context Of Health Sector Reforms In Ghana, Harriet Birungi, Philomena Nyarko, Ian Askew, Ayorinde Ajayi, Gifty Addico, Edward Addai, Caroline Jehu-Appiah

Reproductive Health

This report outlines results of an in-depth assessment carried out in Ghana in order to provide a better understanding of key factors affecting reproductive health (RH) prioritization at the district level; and to make recommendations for policy dialogue, advocacy, resource allocation, and RH program implementation. In particular, the study examined whether or not districts are connecting to the central process of priority setting and reasons for not doing so. The report includes recommendations for bridging the policy implementation gap, including: ensuring that RH advocates participate in national policy dialogue; investing in systems development for procurement and delivery of drugs and …

Operations Research To Improve Financial Sustainability In Three Bolivian Ngos, Martha Merida, Javier Arce, Douglas Moscoso, Carlo Ramirez, Patricia Riveros, John H. Bratt

Reproductive Health

The FRONTIERS project worked with three Bolivian NGOs (Prosalud, the Center for Research, Education and Services or CIES, and the Association of Rural Health Programs or APSAR) to improve their ability to conduct research on market analysis and cost recovery. Following a one-week workshop on conducting cost studies, staff from the three NGOs designed operations research studies to help with decisions on planning and cost recovery. Study findings showed that cost recovery varied from high (Prosalud, 83-109%) to low (CIES, 38-46%) and very low (APSAR, 10-25%), depending on the service. All three studies focused on alternative options to client fees, …

Variations Among Regions And Hospitals In Managing Chronic Illness: How Much Care Is Enough?, John E. Wennberg

Center for Policy Research

Classic epidemiology looks at what happens to people who live in a defined region over time. For example, birth rate, the number of births that occur among populations over a year, is a common statistics that we're all familiar with. Since the early 1990s we have conducted research at Dartmouth Medical School to convert that classic epidemiologic perspective into looking at what is happening in terms of the health care system itself. We ask how much care people are getting in different regions of the country. We want to know the patterns of that care. And we want to get …

Mental Illness And Barriers To Health Care Access, Charlene Powell

MPA/MPP/MPFM Capstone Projects

Statement of Problem

Access to health care in the United States is major concern, despite the fact that the country spends more per capita on health care than any other country. Individuals with mental illness may face greater access problems than the general population.

Research Question

• Does mental illness predict greater difficulties with access to health care?

Methodology

The 2004 National Health Interview Survey (NHIS) was used to examine the barriers to health care among individuals reporting a mental illness diagnosis. Nine questions relating to health access problems were drawn from the survey and combined into an access index. Multivariate …

Changing Economic Incentives In Long-Term Care, R. Tamara Konetzka

Center for Policy Research

Just as managed care has changed utilization and incentives in other parts of health care, there is a whole set of incentives built around long-term care that really matter. For example, if nursing homes have a financial incentive to hospitalize people with certain health conditions, then in the long run they are not going to develop the programs and invest in the resources to treat those people in the facility. Instead they're going to use those resources to stay in business or to provide other types of care. And while we can assume that policymakers do not create regulations that …

World Health Organization, Wendy Braun

Human Rights & Human Welfare

Over the past 60 years the World Health Organization (WHO) has succeeded in improving the general standard of health around the world. The WHO is an international agency within the United Nations and is comprised of 192 countries. The World Health Assembly, a 34 member elected board, meets annually to determine new regulations and budgetary needs for the organization. Rights-based policy is integrated throughout the World Health Organization’s programs. The WHO works with several entities, including non-governmental organizations, U.N. agencies and private organizations to achieve goals and implement new programs. Key topics for the WHO include gender rights, policy, and …

World Bank, Adrienne Stohr

Human Rights & Human Welfare

The mission of the World Bank is to aid developing countries stabilize their economies through financial and technical assistance. The five dominant themes that emerge in a review of the World Bank literature are: health, gender, environment, globalization, and global governance. Each of these themes is broadly related to issues that consistently influence the larger issue of how the World Bank incorporates, rejects, or impacts human rights.

Calibrating The Wealth And Health Of Nations: Trade, Health, And Foreign Policy After The Wto's First Decade, David P. Fidler

Articles by Maurer Faculty

One of the most important themes to emerge from the relationship between trade and health in the first ten year's of the WTO's existence is the challenge of achieving policy coherence. This task is a foreign policy challenge for WTO Members, which requires looking at the relationship between trade and health against the backdrop of the making and implementing of foreign policy. Policy coherence has generally become a major concern for foreign policymakers because post-Cold War trends, such as accelerating globalization, seriously challenge traditional foreign policy assumptions, practices, and institutions. Part of this new context for foreign policy involves the …

Health And Foreign Policy, David P. Fidler, Nick Drager

Articles by Maurer Faculty

No abstract provided.

Contesting Anticompetitive Actions Taken In The Name Of The State: State Action Immunity And Health Care Markets, Clark C. Havighurst

Faculty Scholarship

The so-called state action doctrine is a judicially created formula for resolving conflicts between federal antitrust policy and state policies that seem to authorize conduct that antitrust law would prohibit. Against the background of recent commentaries by the federal antitrust agencies, this article reviews the doctrine and discusses it's application in the health care sector, focusing on the ability of states to immunize anticompetitive actions by state licensing and regulatory boards, hospital medical staffs, and public hospitals, as well as anticompetitive mergers and agreements. Although states are free, as sovereign governments, to restrict competition, the state action doctrine requires that …