Health Policy Commons^™

Indonesia Diagnosis Related Groups, Ronnie Rivany

Kesmas

Di Amerika dan Australia, Kelompok Diagnosis Terkait (Diagnosis Related Group’s ) (DRGs) adalah suatu cara mengidentifikasi dan mengelompokkan pasien yang mempunyai kebutuhan dan sumber yang sama dirumah sakit berdasarkan alur perjalanan klinis (Clinical Pathway ). Penyakit yang mempunyai co morbidity atau co mortality, disebut Casemixdan mempunyai kode yang memperlihatkan derajat keparahan kelompok penyakit sehingga secara linear akan mempengaruhi besaran biaya perawatan. Dengan demikian, pembayaran perawatan di rumah sakit akan dilakukan berdasarkan “kesembuhan“ (cost of treatment per diagnosis), dan bukan berdasarkan penggunaan pelayanan medis dan non medis (fee for services). Di Indonesia sampai kini belum ada model perhitungan biaya untuk pembayaran …

Kepuasan Pasien Dan Kunjungan Rumah Sakit, Hafizurrachman Hafizurrachman

Kesmas

Kepuasan pasien ternyata tidak selalu meningkatkan kunjungan pasien di fasilitas pelayanan kesehatan. Penelitian ini bertujuan mengetahui hubungan kepuasan pasien dengan jumlah kunjungan di rumah sakit. Penelitian ini menggunakan data primer survei pelayanan di rawat jalan dan rawat inap selama 9 periode pengukuran pada 2007 – 2009 dan data sekunder kunjungan rumah sakit pada periode yang sama, jumlah sampel adalah 125 pasien per periode yang diambil dengan metoda stratified random sampling. Analisis dilakukan secara analisis time series dengan metode tren kuadrat terkecil (Least Square Method ), analisis regresi sederhana dan analisis uji perbedaan tiga atau lebih rata-rata (Uji-Kruskal Wallis). Penelitian ini …

Kinerja Bidan Di Desa Dalam Program Jaminan Pemeliharaan Kesehatan Masyarakat Miskin, Arfah Husna, Besral Besral

Kesmas

Cakupan pelayanan kebidanan program Jaminan Pelayanan Kesehatan Masyarakat Miskin (JPKMM) di Kabupaten Aceh Selatan tahun 2006 yang belum mencapai target mengindikasikan kinerja bidan di desa dalam pelayanan kebidanan program JPKMM masih rendah. Penelitian ini bertujuan mengetahui kinerja bidan desa dan faktor-faktor yang berhubungan. Kinerja bidan desa diukur dengan melihat cakupan pelayanan kebidanan program JPKMM meliputi cakupan pemeriksaan kehamilan minimal 4 kali dan cakupan pertolongan persalinan. Disain penelitian yang digunakan adalah cross sectional dengan populasi seluruh bidan desa yang bertugas di Kabupaten Aceh Selatan tahun 2007. Sampel adalah bidan desa yang sudah bertugas minimal setahun yang berjumlah 104 orang. Disimpulkan bahwa …

Health Center Data Warehouses: Opportunities And Challenges For Quality Improvement, A. Seiji Hayashi, Emily Jones, David M. Stevens, Peter Shin, Brad Finnegan, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This Policy Research Brief reports on a pilot effort to leverage the growing presence of health center data warehouses to advance health care quality improvement through data sharing and exchange. This project builds on a partnership between the Michigan Primary Care Association and The George Washington University's Geiger Gibson/RCHN Community Health Foundation Research Collaborative that centers on developing approaches to using existing health center data for quality improvement.

Do Medicaid And Chip Measure Errors Correctly?, Leighton C. Ku

Health Policy and Management Issue Briefs

Measuring and reducing errors in Medicaid and CHIP is important, but the current program and the proposed regulatory provisions are flawed and misleading. Reducing errors should involve not only reducing payments that are issued in error, but reducing the rate at which eligible applicants are erroneously denied Medicaid coverage. CMS should give develop a better, more valid approach to error determination when there are cases of missing or insufficient provider or eligibility data and issue a new proposed rule that offers a new approach or approaches.

Use Of Revised International Health Regulations During Influenza A (H1n1) Epidemic, 2009, Rebecca L. Katz

Health Policy and Management Faculty Publications

Strong international health agreements and good planning created a structure and common procedure for nations involved in detection and evaluation of the emergence of influenza A (H1N1). This report describes a timeline of events that led to the determination of the epidemic as a public health emergency of international concern, following the agreed-upon procedures of the International Health Regulations. These events illustrate the need for sound international health agreements and should be a call to action for all nations to implement these agreements to the best of their abilities.

Network Governance And Health Care Policy, M. Ernita Joaquin, Nathan Meyers

Public Policy and Leadership Faculty Research

As a paradigm, network governance is trumping “public administration” or traditional models of government. Policies taking a network governance approach seem to have a greater chance of goal
/="/">attainment. Is network governance in health care policy a means of bridging the ideological divide, what with national health policy initiatives tripping on partisan hurdles? One example of network governance (as expounded by Stephen Goldsmith and William Eggers in their 2004 book) at the state level is high-risk health insurance programs (HRPs).

Emergency Department Operations In Top-Performing Safety-Net Hospitals, Lea Nolan, Marsha Regenstein, Donna Anthony, Bruce Siegel

Health Policy and Management Faculty Publications

This report profiles five safety-net hospitals—Boston Medical Center, Denver Health, Memorial Regional Hospital, Memorial Hospital West, and Virginia Commonwealth University Health System—that made improvements to curb emergency department (ED) crowding, reduce long waits, and lower the number of hours spent on ambulance diversion. Hospitals used a combination of interventions, including: reconfiguring the ED to maximize efficiency; devising a pre-diversion system to alert staff of ED crowding; installing an electronic tracking system; designating staff members to be responsible for tracking patients; and developing meaningful performance metrics. To be successful, such interventions need to take place within a broader improvement strategy that …

Community Health Centers In Indiana: State Investments And Returns, Avi Dor, Patrick Richard, Ellen Tan, Sara J. Rosenbaum, Peter Shin, Lee Repasch

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Indiana Community Health Centers (I-CHC), including Federally Qualified Health Centers (FQHCs) and State Funded Health Centers (SFHCs), play a vital role in caring for the state's most vulnerable populations. Although their patient base tends to be poorer and experience greater health challenges than the general population, these health centers have generated substantial health care savings while providing high quality, low cost care. In this brief, key findings are presented from a recent study, conducted for the Indiana State Department of Health by GWU faculty and staff that was designed to estimate the cost savings and benefits generated by the state's …

Fair Process In Physician Performance Rating Systems: Overview And Analysis Of Colorado's Physician Designation Disclosure Act, Lara Cartwright-Smith, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Programs to rate, grade, rank, or tier physicians based on quality or other measures are becoming more commonplace as the demand for greater transparency and accountability in the nation’s health care system intensifies. For many years, the preferred provider organization (PPO) reflected the most basic form of tiering—physicians were either included or excluded from the PPO network. However, this approach has become more refined as the tools for evaluating physician performance have evolved.

Estimating The Effects Of Health Reform On Health Centers' Capacity To Expand To New Medically Underserved Communities And Populations, Leighton C. Ku, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Nearly 100 million persons reside in urban and rural communities that can be considered medically underserved as a result of inadequate supply of primary care physicians and elevated health risks. A report by the National Association of Community Health Centers and the Robert Graham Center estimated that 60 million people are "medically disenfranchised" and lack access to adequate primary health care because of where they live, even though many have health insurance. This brief assesses the potential effects of national health reform on health centers and on the number of patients they can serve. Because improving primary care access is …

Antitrust Aspects Of Health Information Sharing By Public And Private Health Insurers, Taylor Burke, Lara Cartwright-Smith, Erica Pereira, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

This policy brief is the first of two to address antitrust considerations that arise in health system transformation aimed at producing greater clinical integration and greater levels of information about the quality and cost of care. The second policy brief will discuss the implications of several recent Federal Trade Commission rulings on physician joint contracting to achieve clinical integration and greater health information accountability. These rulings have significant implications for growing efforts, as part of health reform, to create entities known as accountable care organizations.

National Health Reform: How Will Medically Underserved Communities Fare?, Sara J. Rosenbaum, Emily Jones, Peter Shin, Leighton C. Ku

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This brief examines the factors underlying medical underservice. It finds that the number of Americans living in communities at risk for medical underservice is more than double the number of persons who are uninsured. The report notes that even with health insurance reform, these communities and providers that serve them will continue to be affected by elevated numbers of low income uninsured persons, as well as persons who may be seriously under-insured because of poorer health status and lower family income.

Describing health insurance expansion as the single most important strategy to alleviate medical underservice, the Brief also identifies a …

Insurance Discrimination On The Basis Of Health Status: An Overview Of Discrimination Practices, Federal Law, And Federal Reform Options, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Actuarial underwriting, or discrimination based on an individual's health status, is a business feature of the voluntary private insurance market. The term "discrimination" in this paper is not intended to convey the concept of unfair treatment, but rather how the insurance industry differentiates among individuals in designing and administering health insurance and employee health benefit products. Discrimination can occur at the point of enrollment, coverage design, or decisions regarding scope of coverage. Several major federal laws aimed at regulating insurance discrimination based on health status focus at the point of enrollment. However, because of multiple exceptions and loopholes, these laws …

Boosting Health Information Technology In Medicaid: The Potential Effect Of The American Recovery And Reinvestment Act, Brad Finnegan, Leighton C. Ku, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

The American Recovery and Reinvestment Act of 2009 (ARRA) will invest approximately $49 billion to expedite health information technology (HIT) adoption through Medicare and Medicaid. Our analysis of 2006 NAMCS data found that approximately 15 percent of the practicing office-based physicians in the country would qualify for up to $63,750 over six years in Medicaid financial incentives for HIT adoption. Included within the 45,000 eligible physicians are about 99 percent of all community health center physicians. If all qualifying physicians apply for the Medicaid incentives and receive the maximum level of payments, the federal government would invest more than $2.8 …

Medicaid's Medical Transportation Assurance: Origins, Evolution, Current Trends, And Implications For Health Reform, Sara J. Rosenbaum, Nancy Lopez, Melanie J. Morris, Marsha Simon

Health Policy and Management Issue Briefs

This 24-page policy brief examines Medicaid's assurance of medical transportation in the context of medically necessary but non-emergency health care. Reviewing the origins and evolution of the assurance and presenting the results of a 2009 survey of state Medicaid programs, the results of this analysis underscore Medicaid's unique capacity to not only finance medically necessary health care but also the services and supports that enable access to health care by low income persons since Medicaid covers non-emergency medical transportation. This ability to both finance health care and enable its use moves to the forefront as Congress considers whether to assist …

Improving Medicaid's Continuity Of Coverage And Quality Of Care, Leighton C. Ku, Patricia Mactaggart, Fouad Pervez, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Medicaid provides health insurance coverage to tens of millions of low-income children, parents, seniors and people with disabilities. Unfortunately, Medicaid enrollment is like a leaky sieve; every year millions of people enroll, only to subsequently lose their coverage, despite still being eligible, because of inefficient and cumbersome paperwork requirements. The interruptions in coverage affect the continuity and effectiveness of health care received. Interruptions also impair quality monitoring and improvement activities because many Medicaid enrollees were not enrolled long enough to assess the quality of their care. The presumption is that people who have been enrolled for less than a year …

Paying Medicare Private Plans By Competitive Bidding: Not The Same As Costs In Regular Medicare, Brian Biles, Jonah Pozen

Health Policy and Management Faculty Publications

Medicare Advantage plans are now paid $11 billion a year, and $150 billion over 10 years, more than costs in regular fee-for-service (FFS) Medicare. In the past two years there have been discussions about reducing MA payments to the level of 100 percent of average costs in FFS and using the savings to offset the costs of new Federal health initiatives such as health care reform. Earlier this year, OMB proposed "reducing Medicare overpayments to private insurers through competitive payments." Under this proposal, MA plan "payments would be based on an average of plans' bids submitted to Medicare." This issue …

Complexity, Cofactors, And The Failure Of Aids Policy In Africa, Eileen Stillwaggon

Economics Faculty Publications

Global AIDS policy still treats HIV as an exceptional case, abstracting from the context in which infection occurs. Policy is based on a simplistic theory of HIV causation, and evaluated using outdated tools of health economics. Recent calls for a health systems strategy – preventing and treating HIV within a programme of comprehensive health care – have not yet influenced the silo approach of AIDS policy.

Evidence continues to accumulate, showing that multiple factors, such as malnutrition, malaria and helminthes, increase the risk of sexual and vertical transmission of HIV. Moreover, complementary interventions that reduce viral load, improve immune response, …

Implementasi Program Asuransi Kesehatan Masyarakat Miskin Di Nusa Tenggara Timur, Tri Rini Puji Lestari

Kesmas

Kesehatan merupakan hak asasi manusia, sehingga upaya pelayanan pengobatan untuk penduduk miskin tidak boleh dipandang sebagai sesuatu yang konsumsi, tetapi sebagai investasi untuk mencapai masyarakat yang sejahtera. Penelitian ini bertujuan mendapatkan informasi tentang akses penduduk miskin pada pelayanan rumah sakit melalui program Askeskin di Nusa Tenggara Timur (NTT). Penelitian menggunakan pendekatan kualitatif dengan informan kunci adalah pejabat di RSU Prof. DR. W.Z. Johannes NTT dan PT Askes cabang Kupang. Hasil penelitian memperlihatkan bahwa jumlah kartu yang diterbitkan tidak sesuai dengan realita jumlah maskin dan ada oknum tidak maskin yang menggunakan fasilitas Askeskin. Juga ditemukan beberapa obat yang tercantum dalam formularium …

Pengetahuan, Sikap Dan Persepsi Petugas Gawat Darurat Terhadap Kesalahan Medik, Refi Fitri Hamdani Nasution

Kesmas

Kesalahan medik serius paling sering terjadi di intensive care unit, ruang operasi, dan unit gawat darurat. Tujuan penelitian ini mendapat informasi tentang pengetahuan, sikap, dan persepsi tenaga kesehatan terhadap kesalahan medik. Penelitian dilakukan terhadap manajer, kepala seksi, kepala ruangan, ketua kelompok perawat, dokter dan perawat pelaksana. Metode yang digunakan adalah metode kualitatif meliputi wawancara mendalam, observasi, dan telaah dokumen. Metode analisis yang digunakan adalah analisis konten yg membandingkan hasil penelitian dengan teori. Ditemukan bahwa pengetahuan, sikap, dan persepsi tenaga kesehatan cukup baik, tetapi belum diikuti tindakan, sarana prasarana dan pengawasan yang memadai. Sistem rujukan pasien yang kurang baik menyulitkan keluarga …

Budaya Organisasi, Kepuasan Kerja Dan Komitmen Dokter Spesialis Di Rsud Kota Bekasi, Ni Made Sumartini

Kesmas

Komitmen dokter pada rumah sakit mempengaruhi tingkat kehadiran, produktivitas dan mutu pelayanan di rumah sakit. Waktu dan tenaga yang tidak penuh diberikan dokter spesialis pada rumah sakit berpengaruh terhadap produktivitas yang kurang optimal. Tujuan penelitian ini menilai hubungan budaya organisasi, kepuasan kerja dengan komitmen dokter spesialis. Penelitian ini dilakukan pada 35 responden dokter spesialis dengan menggunakan pengukuran organinizational culture survey Denison, a job satisfaction survey Spector dan organizational commitment Allen & Meyer dengan skala yang dimodifikasi. Metoda analisis kuantitatif yang digunakan adalah univariat, bivariat dan multivariat. Sumber kepuasan dokter spesialis dengan komitmen yang tinggi adalah rekan kerja dan pekerjaan. Sumber …

Pemenuhan Hak Konsumen Di Institusi Pelayanan Kesehatan Di Kota Bandung Dan Kota Cimahi, Juariah Juariah

Kesmas

Kebijakan pelayanan medis secara legal formal telah memberikan perlindungan hak konsumen kesehatan. Namun, sampai kini belum terungkap upaya institusi pelayanan kesehatan untuk memenuhi dan melindungi hak konsumen kesehatan. Penelitian ini bertujuan mengeksplorasi berbagai kebijakan pemenuhan hak-hak konsumen kesehatan oleh institusi pelayanan kesehatan pemerintah dan swasta. Penelitian yang menggunakan pendekatan kualitatif dengan metode studi ini dilaksanakan pada Agustus 2008 - Januari 2009 di institusi pemerintah RSUD Cibabat-Cimahi, RSKIA Astanaanyar dan Puskesmas Garuda serta institusi swasta RS Muhammadiyah dan RB Barokah. Data dikumpulkan dengan telaah dokumen dan wawancara mendalam terhadap lima orang informan serta dianalisis dengan analisis isi. Hasil penelitian meliputi: tiga …

Tri-Committee Draft Proposal For Health Care Reform, Fitzhugh Mullan

Health Policy and Management Congressional Testimonies

The Tri-Committee draft legislation takes a significant step towards establishing a health care workforce which will sustain a high-quality, cost-effective, fully accessible health care system. Moves to establish an Advisory Committee on Health Workforce Evaluation and Assessment, re-invest in the National Health Service Corps and Title VII of the Public Health Service Act, redistribute unused Medicare GME positions to primary care programs and establish teaching health centers, and address payment and practice challenges to primary care through the medical home and accountable care organization pilot programs are all positive moves towards a sustainable health care workforce. However, to fully achieve …

Women's Health And Health Care Reform: The Economic Burden Of Disease In Women, Susan F. Wood, Avi Dor, Rebekah E. Gee, Alison Harms, D. Richard Mauery, Sara J. Rosenbaum, Ellen Tan

Health Policy and Management Faculty Publications

This report estimates the direct and indirect costs of care for women for the major chronic diseases and conditions that women face across the lifespan. It also identifies the key primary care and preventive services that can lead to prevention, early detection or early intervention for these conditions. Health care screening, counseling, early diagnosis, and early intervention health care services are important for women at each stage of their lives. But women typically seek care in primary care settings for family planning services and cancer screening prior to becoming pregnant. As a result, high quality care during the reproductive years …

Opportunities For Comparative Research In Public Health Pbrns : A Baseline Analysis Of Local Practice Settings, Glen P. Mays, Sharla A. Smith, Elaine B. Wootten, Sylvia J. Porchia

Health Management and Policy Presentations

This analysis describes the organizational and operational characteristics of local public health agencies participating in an initial cohort of five (5) public health PBRNs in the U.S. We examine variation in practice settings within and between PBRNs; compare practice settings to state and national norms; and identify opportunities for comparative research that can be conducted through PBRNs.

Health Insurance Fraud: An Overview, Sara J. Rosenbaum, Nancy Lopez, Scott Stifler

Health Policy and Management Faculty Publications

In 2007, the U.S. spent nearly $2.3 trillion on health care and public and private insurers processed more than 4 billion health insurance claims. The National Health Care Anti-Fraud Association (NHCAA) has estimated that, conservatively, 3% of all health care spending—or $68 billion—is lost to health care fraud. Other estimates by government and law enforcement agencies place fraud-related losses as high as 10% of annual health care spending; at this rate, the losses in 2007 alone – over $220 billion – would have been enough to cover the uninsured.

This report, funded by the Robert Wood Johnson Foundation, delves into …

Medicaid And Case Management To Promote Healthy Child Development, Sara J. Rosenbaum, Kay Johnson, Emily Jones, Anne R. Markus

Health Policy and Management Faculty Publications

This policy brief presents options for financing and delivering case management services to low-income and special-needs children in Medicaid. The analysis builds on a literature review of case management, a review of the legal underpinnings of Medicaid case management, and consultation with experts in the fields of health care finance and program operations. It aims to inform the policy community about the importance of case management for assuring the health and development of our youngest and most vulnerable children.

The Application Of The Emergency Medical Treatment And Labor Act (Emtala) To Hospital Inpatients, Lara Cartwright-Smith, Sara J. Rosenbaum, Karen Belli, Elaine Purcell, Tasmeen S. Weik

Health Policy and Management Issue Briefs

This issue brief provides a brief overview of the Emergency Medical Treatment and Labor Act (EMTALA) and focuses on its application to hospital inpatients. EMTALA applies differently to patients than non-patients, and also applies differently to patients admitted through the emergency department than patients admitted as regular inpatients. In addition, courts and the Centers for Medicare and Medicaid Services (CMS) have differed in their interpretation of the statute. Depending on the specific facts of any particular case, EMTALA may or may not have implications for specialty-related transfers and discharges.

Degrees Of Institutionalization: Family Planning Policies And Programs In Senegal, 1980-2005, Yazmine Michelle Watts

Dissertations

Senegal's population growth rate of 2.7% is greater than double that of the world average of 1.16%. The Government of Senegal acknowledges the population problem and has made efforts to address this issue. For over the past two decades the United States Agency for International Development (USAID) has served as the predominant donor in Senegal's health sector and has been a strong supporter of Senegal's family planning program. The evolution of family planning in Senegal cannot be understood without considering the roles of culture, religion, decentralization and funding in the institutionalization process. This research addresses important questions concerning factors that …