Health Policy Commons^™

Serving American Veterans: A Review And Analysis Of Gaps In Service In The Needs Of Veterans, Mary Elisabeth Germann

Baker Scholar Projects

The United States Department of Veterans Affairs is the agency of the federal government that is responsible for providing benefits, health care, and cemetery services to US military Veterans and their families. About a quarter of the nation’s population, approximately 70 million people, are potentially eligible for VA benefits and services because they are veterans, family members, or survivors of veterans. Due to this expansive demand, the United States has developed the most comprehensive system of Veterans assistance programs in the World. But many argue that the US VA still falls short of expectations and fails to fulfill the needs …

Rural Working-Age Adults Report More Cost Barriers To Health Care, Erika C. Ziller Phd, Carly Milkowski Mph, Amanda Burgess Mppm, Mph

Access / Insurance

Using the 2019-2020 National Health Insurance Survey, researchers at the Maine Rural Health Research Center examined rural-urban differences in affordability of care and cost-saving strategies among working-age adults. Rural adults (18-64) were more likely than their urban counterparts to report problems paying, or being unable to pay, their medical bills. They were also more likely to delay or go without needed care because of the cost. Compared with urban adults, those in rural areas were more likely to engage in prescription drug cost-saving measures such as skipping doses, delaying refills, or taking less medication than prescribed. For all affordability measures, …

Patterns Of Health Care Use Among Rural-Urban Medicare Beneficiaries Age 85 And Older, 2010-2017, Yvonne Jonk Phd, Heidi O'Connor Ms, Amanda Burgess Mppm, Carly Milkowski Mph

Access / Insurance

The purpose of this study was to examine rural-urban differences in health care use among Medicare beneficiaries age 85+. Understanding these differences, and the socioeconomic characteristics that contribute to them, can have important implications for Medicare policies aimed at serving the age 85+ population. Using the Medicare Current Beneficiary Survey 2010-13 Cost and Use and 2015-17 Cost Supplement Files, we examined whether and how rural and urban Medicare beneficiaries age 85+ differ in terms of their:

1. socioeconomic and health characteristics that may inform health care use;
2. trends in health care use, including use of inpatient and emergency department (ED) care; …

Executive Summary: Driving The Southern Nevada Health Economy Forward, Tripp Umbach

Policy Briefs and Reports

The University of Nevada, Las Vegas (UNLV) plans to develop an integrated academic health center within the Las Vegas Medical District (LVMD).1 The academic health center includes UNLV’s five health science schools and mental and behavioral health, which is distributed among several colleges (medicine, liberal arts, urban affairs, and education) in the university. University Medical Center (UMC), a major teaching hospital, will also be an important driver of the academic health center. For the purposes of this report, UNLV’s medical and health science entities along with UMC are referred to collectively as the UNLV Academic Health Center.

Driving The Southern Nevada Health Economy Forward: Benefits Of A Transformational Unlv Academic Health Center, Tripp Umbach

Policy Briefs and Reports

The University of Nevada, Las Vegas (UNLV) plans to develop an integrated academic health center within the Las Vegas Medical District (LVMD). The academic health center includes UNLV’s five health science schools and mental and behavioral health, which is distributed among several colleges (medicine, liberal arts, urban affairs, and education) in the university. University Medical Center (UMC), a major teaching hospital, will also be an important driver of the academic health center. For the purposes of this report, UNLV’s medical and health science entities along with UMC are referred to collectively as the UNLV Academic Health Center. Additional academic health …

Usage And Impact Of Benefits Among Frontline Healthcare Workers, Mathieu Despard

Social Policy Institute Research

We completed a study about frontline healthcare workers – the benefits they get through work and how they are doing financially. This brief provides highlights from our survey to 2,321 workers and interviews with 30 workers.

Combatting Rising Healthcare Costs For Healthier Adults, Alejandra Muñoz-Rivera

Social Policy Institute Research

In 2020, healthcare expenditures averaged $12,530 per person, up 9.7% from 2019. In 2018, 19% of U.S. households had medical debt with $2,000 being the median amount owed. Over half of adults between 18 to 64 years of age are estimated to experience some form of medical financial hardship including medical bills or debt, stress about medical bills, and delaying or forgoing treatment specifically due to cost. In a 2022 survey of 140 Medicaid and Marketplace members by researchers from the Social Policy Institute (SPI) and the Centene Center of Health Transformation, one-third of respondents reported having unpaid medical bills. …

The Financial Implications Of The Chinese Healthcare System, Lilly Schneider, Chi Hung Kenneth Leung

DU Undergraduate Research Journal Archive

In 1949 one of the world’s most powerful and influential countries was born: The People’s Republic of China. Perhaps the greatest challenge the country has consistently faced since its inception has been ensuring a fiscally sound healthcare system. Today, China has the world’s largest population and a rapidly aging society with 330 million citizens over the age of 65 projected by 2050- nearly the same size as the total U.S. population. Living standards across China have been drastically increasing in recent decades and the Chinese people are desiring better, higher quality healthcare to complement their new lifestyles. With this desire …

Health Care And Education Access Of Transnational Children In Mexico, Catalina Amuedo-Dorantes, Laura Juarez

Mission Foods Texas-Mexico Center Research

Between 2001 and 2018, more than 5.5 million Mexican migrants were removed from the United States or returned to Mexico with their families as immigration enforcement escalated. Learning how this transition affected the access to health and education services of their children –also referred to as “the invisibles”– is a policy-relevant topic for both the United States and Mexico. Using representative data on 7.6 million Mexican and U.S.-born children from the 2015 Mexican Intercensal Survey, we provide evidence on the education and health care access gaps between these two groups and on the factors potentially responsible for the barriers encountered …

Improving Health Care In Nevada, Ember Smith, Kaylie Pattni

Policy Briefs and Reports

Across the United States, improvements in health outcomes lag while health care costs rapidly rise. Medical personnel and resource shortages combined with high underinsured and uninsured rates further complicate access to quality, affordable health care. In order to better understand state-level solutions, we explore factors that contribute to health care deficiencies and emphasize Nevada’s unique obstacles.

Many Older Americans Do Not Receive The Recommended Home Health Care After Hospitalization, Jun Li, Mingyu Qi, Rachel M. Werner

Population Health Research Brief Series

Only 54% of Medicare patients referred to home health care services following a hospitalization received home health care visits. Policymakers must address this discrepancy to ensure all patients receive the home health services they need.

The Collapse Of Health Care: The Effects Of Covid-19 On U.S. Community Health Centers, Ashley Van Slyke

Population Health Research Brief Series

The closure of community health centers is likely to have widespread detrimental impacts on the country’s public health and economy for years to come.

What's Left Of The Affordable Care Act?, Helen Levy, Andrew Ying, Nicholas Bagley

Articles

We assess the progress of the Affordable Care Act a decade after it became law. Although most of it remains intact, some parts have been repealed and others have not been implemented as expected. We review how and why the law has aged. Legal challenges have done less damage than is commonly appreciated, with the exception of the Supreme Court case that thwarted full expansion of Medicaid. Most of the important changes have other sources. Some parts were born to fail. Others were dismantled in response to interest-group pressure. Still others have failed to thrive for any number of reasons. …

Universal Healthcare: Solution Or Delusion? Comparing Medicare For All, Public Option, And Business-As-Usual Models Among U.S. Democratic Presidential Candidates, Elizabeth Pinchman

Honors Theses

How much longer can the United States remain the only developed country without universal health insurance? While the U.S. leads the world in healthcare costs per capita, it trails behind in access and quality measures. Many Americans live in fear of medical bankruptcy, especially the twenty-six million people who remain uninsured. The Democratic presidential candidates vying for the nomination in 2020 have released plans to resolve these problems and bring the nation closer to universal coverage.

Through the analysis of proposed actions, plan feasibility, and expected impact, the candidates’ suggestions have been evaluated within the context of the United States. …

Covid-19: Hospital And Intensive Care Unit (Icu) Bed Capacity In The Mountain West, Ember Smith, Kaylie Pattni, Caitlin Saladino, William E. Brown

Health

Utilizing the Harvard Global Health Institute’s (HGHI) COVID-19 projections, this fact sheet examines the potential hospital and ICU bed shortages in the Mountain West region: Arizona, Colorado, New Mexico, Nevada, and Utah.

Our Female Veterans Deserve Better Healthcare, Mariah Brennan Nanni

Population Health Research Brief Series

Women represent one of the fastest growing segments of the U.S. military, but their access to comprehensive reproductive healthcare is lacking. This issue brief explains gaps in healthcare coverage for female veterans and ways to address them.

Healthcare: A Universal Human Right Or White Privilege?, Nicole E. Heller

Student Publications

It is an undeniable fact that racism has been present in the United States since the beginning of the European colonization of the nation. Structural racism and implicit biases are the modern reality of the African American experience, reflecting years of direct racial targeting, mistreatment and discrimination. Today, there are many examples of deeply rooted racial discrepancies, de facto segregation, and modern acts of colonization. Perhaps one of the most troubling disparities present between African Americans and white Americans is the alarming difference in their experiences with healthcare. After a long history of medical torture, mistreatment, and a denial of …

Twelve Principles To Support Caregiver Engagement In Health Care Systems And Health Research, Kerry Kuluski, Kristina M. Kokorelias, Allie Peckham, Jodeme Goldhar, John Petrie, Carole Anne Alloway

Patient Experience Journal

Family and friend caregivers (i.e., unpaid carers) play a critical role in meeting the needs of people across various ages and illness circumstances. Caregiver experiences and expertise, which are currently overlooked, should be considered in practice (such as designing and evaluating services) and when designing and conducting research. In order to improve the quality of health care we need to understand how best to meaningfully engage caregivers in research, policy and program development to fill this important gap. Our study aimed to determine principles to support caregiver engagement in practice and research. A pan Canadian meeting brought together 48 stakeholders …

Health Care's Market Bureaucracy, Allison K. Hoffman

All Faculty Scholarship

The last several decades of health law and policy have been built on a foundation of economic theory. This theory supported the proliferation of market-based policies that promised maximum efficiency and minimal bureaucracy. Neither of these promises has been realized. A mounting body of empirical research discussed in this Article makes clear that leading market-based policies are not efficient — they fail to capture what people want. Even more, this Article describes how the struggle to bolster these policies — through constant regulatory, technocratic tinkering that aims to improve the market and the decision-making of consumers in it — has …

Gettysburg Social Sciences Review Fall 2018

Gettysburg Social Sciences Review

No abstract provided.

An Ambivalent Embrace: Service Needs And Gaps For Asian Immigrants In New Destinations, John J. Chin

Journal of Health Disparities Research and Practice

Asian immigrants to the U.S. are settling in "new destinations," but there has been little research on their health care and social service needs. Our analysis of Census data to identify cities with the fastest Asian immigrant population growth (1990-2000) yielded 33 smaller cities in 13 states. The cities ranged in population from 7,677 to 86,660; were spread across 13 states in the Northeast, South, and Midwest regions of the US; and varied widely demographically. Pilot surveys conducted in 2009 indicated that, although many residents had positive attitudes towards immigrants, many were also concerned about job competition and dilution of …

Public Schools, And Health Care: A Strategy To Promote Social Inclusion, Jana Sladkova, Anahi Viladrich, Nicholas Freudenberg

Occasional Paper Series

Sladkova, Viladrich, and Freudenberg refer to “social inclusion” as the process through which the newly arrived find their voice in an already complex, cacophonous society. They describe an approach to social inclusion for adult immigrants that melds learning English at the same time as learning to negotiate our often-Byzantine health care system. They highlight programs that work and a new perspective on how to maximize the effectiveness of limited adult education opportunities.

University Of Tennessee, Knoxville Undergraduate Students’ Awareness And Opinions Of The Patient Protection And Affordable Care Act (Aca), Mary Jennings Hardee

Chancellor’s Honors Program Projects

No abstract provided.

A Bottom-Up Approach To Effectively Implementing A Good Samaritan Policy At Bryant University, Jessica Fleet

Honors Projects in History and Social Sciences

The rising numbers of substance consumption on college campuses are becoming a public concern for higher educational institutions across the United States. The thesis studies the relationship between state laws and private higher education institution laws in regards to substance abuse. Examining state laws and private universities Medical Amnesty and Good Samaritan laws were used to determine what would effectively replace Bryant University’s current Substance Abuse Policy. The current policy lacks an educational element along with stressing the word of mouth ideology that students are protected when in need of drug or alcohol assistance in a medical situation. This is …

Medicaid And Children With Special Health Care Needs, 2016-2017 Cohort Of New Hampshire-Maine Leadership Education In Neurodevelopmental And Related Disabilities (Nh-Me Lend) Program Trainees

Policy Analysis

Medicaid funds vital services for children and youth with special health care needs and disabilities (CYSHCN). Proposed changes to the structure of Medicaid would significantly reduce federal funding for this important program. The most concerning are the proposed structural changes including per capita caps and block grants, as well as threats to Early and Periodic Screening, Diagnostic and Treatment (EPSDT) and Medicaid Waiver services. Restructuring would have devastating effects on benefits for low-income children and individuals with disabilities, and their families, putting this very vulnerable population at additional risk.

Toward An International Constitution Of Patient Rights, Alison Poklaski

Indiana Journal of Global Legal Studies

In the past decade, medical tourism-the travel of patients across borders to receive medical treatment-has undergone unprecedented growth, fueled by the globalization of health care and related industries. While medical tourism can benefit patients through increased access to treatment and cost-savings, medical travel also raises concerns about ensuring quality of care and legal redress in medical malpractice. Moreover, existing regulations fail to address these unprecedented issues. The multilateral adoption of an International Constitution of Patient Rights (ICPR) is necessary in order to more effectively preserve medical tourism's benefits and guard against its risks.

The Economics Of Health, Donald J. Meyer Editor

Upjohn Press

Donald J. Meyer leads a group of notable health economists who explore critical issues—and their economic impacts—facing the nation's healthcare system today. These include lifestyle choices and their health impacts, decisions on medical care and self-care, the fee-for-service payment model, disability and workers’ compensation insurance claims, long-term care, and how various aspects of the Patient Protection and Affordable Care Act (ACA) impact the nation’s healthcare system. Contributors include M. Kate Bundorf, Marcus Dillender, John H. Goddeeris, Donald J. Meyer, Edward C. Norton, and Charles E. Phelps.

Health Care Service Disparity: Factors Associated With The Distribution Of Primary Care Physicians, Robert L. Morgan

Senior Honors Projects, 2010-2019

Primary care physicians operate on the front lines of health care. Although primary care physicians play a critical role in improving health outcomes, workforce trends in the United States show a growing shortage of primary care physicians as demand for primary care rises. In conveying the importance of primary care physicians, the worsening physician shortage, the inequitable distribution of providers, and the lackluster institutional response thus far, this paper calls into question the effectiveness of current indicators used to identify underserved areas and provide appropriate government assistance. Through the use of data from the 2010 census and American Medical Association …

Trends In Health Care Delivery Systems: Implications For Cancer Prevention And Control, Glen P. Mays

Health Management and Policy Presentations

The Affordable Care Act and larger economic forces are leading both health care providers and public health agencies to renegotiate their roles and responsibilities within the U.S. health system. This session reviews major changes occurring in both health care and public health delivery systems, with a focus on the implications for cancer prevention and control. The information infrastructure created by cancer registries and other health information systems are increasingly important for enabling greater coordination, alignment and accountability within the nation's changing delivery systems.

Allowing Patients To Waive The Right To Sue For Medical Malpractice: A Response To Thaler And Sunstein, Tom Baker, Timothy D. Lytton

Timothy D. Lytton

This essay critically evaluates Richard Thaler and Cass Sunstein’s proposal to allow patients to prospectively waive their rights to bring a malpractice claim, presented in their recent, much acclaimed book, Nudge: Improving Decisions about Health, Wealth and Happiness. We show that the behavioral insights that undergird Nudge do not support the waiver proposal. In addition, we demonstrate that Thaler and Sunstein have not provided a persuasive cost-benefit justification for the proposal. Finally, we argue that their liberty-based defense of waivers rests on misleading analogies and polemical rhetoric that ignore the liberty and other interests served by patients’ tort law rights. …