Public Policy Commons^™

A Socio-Ecological Model Of Affordable Care Act Acceptance, Pratiksha Vaghela

USF Tampa Graduate Theses and Dissertations

Background: Since 1965, there have not been any major revisions of the healthcare laws in the United States, until the recent implementation of the Affordable Care Act (ACA). However, ACA is not well understood and is often controversial. The purpose of this study is to: (1) evaluate the relationship between the employers’ and the employees’ perceptions regarding the ACA mandates for small businesses, (2) evaluate the relationship between the self-reported and the tested knowledge of individuals regarding the ACA mandates for small businesses, and (3) determine if socio-demographic factors influence individual’s perception of the law. Based on the gathered information, …

Comparative Analysis Of Dietary Guidelines In The Spanish-Speaking Caribbean, Melissa Fuster

Publications and Research

Objective: Dietary guidelines are important education and policy tools to address local nutrition concerns. The current paper presents a comparative analysis of nutrition messages from three Spanish-speaking Caribbean countries (Cuba, Puerto Rico and Dominican Republic) to explore how these dietary guidelines address common public health nutrition concerns, contextualized in different changing food environments and food culture similarities.

Design: Qualitative, comparative analysis of current dietary guideline documents and key recommendations.

Results: Key recommendations were categorized into sixteen themes (two dietbased, ten food-based and four ‘other’). Only the Cuban dietary guidelines included diet-based key recommendations. Of the ten food-based …

King V Burwell: Subsidizing Us Health Insurance For Low- And Middle-Income Individuals, Lawrence O. Gostin, Mary C. Debartolo, Daniel Hougendobler

Georgetown Law Faculty Publications and Other Works

In King v. Burwell, the U.S. Supreme Court once again saved the Affordable Care Act (ACA) by upholding subsidies (tax credits) offered to low- and middle-income individuals for insurance bought on federal exchanges. A contrary opinion would have put at risk health insurance for 6.4 million Americans and threatened to destabilize insurance markets for millions more.

The ACA is supported by four interlocking reforms, each of which are necessary to realize its promise of expanding health care coverage: (1) guaranteed issue (prohibiting discrimination based on pre-existing conditions), (2) community rating (barring insurers from imposing higher premiums based on health …

Socially Constructing Drug Addicts From The Poor: A Critical Discourse Analysis, Kalynn Susan Amundson

Graduate Theses and Dissertations

Welfare drug testing was authorized by the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996, and has subsequently garnered extensive legislative interest in numerous states. This policy raises several questions, which are the subjects of the two journal articles and one manuscript included in this dissertation.

The first article addresses the question of a possible confluence of War on Drugs and Welfare Reform policies as evidenced through welfare drug testing policy, and indicated by continuity in policymakers’ rhetoric. This study examines federal-level policymakers’ debate discourse in these two policy streams. The analysis finds themes of the Social pathology, …

Public Health, Universal Health Coverage, And Sustainable Development Goals: Can They Coexist?, Harald Schmidt, Lawrence O. Gostin, Ezekiel Emanuel

Georgetown Law Faculty Publications and Other Works

In her 2012 reconfirmation speech as WHO Director-General, Dr. Margaret Chan asserted: "universal coverage is the single most powerful concept that public health has to offer. It is our ticket to greater efficiency and better quality. It is our savior from the crushing weight of chronic noncommunicable diseases that now engulf the globe ". The UN General Assembly is currently considering proposals for Sustainable Development Goals (SDGs), succeeding the Millennium Development Goals. SDGs, focusing on health, specifically includes universal health coverage (UHC) among its targets. Unquestionably, UHC is timely and fundamentally important. However, its promotion also entails substantial risks. A …

Middle East Respiratory Syndrome: A Global Health Challenge, Lawrence O. Gostin, Daniel Lucey

Georgetown Law Faculty Publications and Other Works

Beginning in May 2015, Middle-East respiratory syndrome (MERS) experienced its first publicly reported “super-spreading” event in South Korea. By mid-June, more than 120 cases and 11 deaths in South Korea had been linked to a businessman returning from travel to Bahrain, United Arab Emirates, the Kingdom of Saudi Arabia and Qatar. Globally more than 1200 had been infected of whom more than 450 died—a high fatality rate of 37%.

What are the most effective legal, social, and public health responses to MERS and other emerging diseases? First, the World Health Organization’s International Health Regulations (IHR) did not effectively guide the …

The Impact Of Nursing Hours And Hospital And Patient Characteristics On Medicare Hospital Acquired Conditions: A National Pooled Cross-Sectional Secondary Data Model And Analysis, Terry Kahlert Eng

Graduate Doctoral Dissertations

Background: Previous research and quality improvement initiatives have underscored the prevalence of healthcare acquired conditions (HACs) and their associated costs in American hospitals. In response to these findings, in 2008, The Centers for Medicare and Medicaid Services identified 10 condition categories that they would no longer pay for if acquired during hospitalization. The conditions were selected based on high cost, high volume, or both, assigned to a higher paying medical severity diagnostic related group (MS-DRG), and were deemed preventable through application of evidence-based guidelines. The Health Quality Outcomes Model and a Path Model guided the study.

Objective: To quantify the …

Improving Rhode Island’S Health Care System: Lessons From The Cuban Model, Sarah R. Moffitt

Senior Honors Projects

Improving Rhode Island’s health care system: lessons from the Cuban model

Cuba is world renowned for its health care system. In regards to international health crises, Cuba is a leader in sending workers abroad and training doctors from all over the world. Within its own borders, the Cuban model provides free access to all citizens in which every individual has a primary care provider. Cuba boasts high vaccination rates, a long life expectancy, low infant mortality rate, and a population that is one of the healthiest in the western hemisphere.

The purpose of this research project is to evaluate the …

Reporting Practices, Knowledge And Opinion Of Policy Regarding Drivers With Dementia Among Arkansas Neurologists And Geriatricians, Erika Martin Gergerich

Graduate Theses and Dissertations

Background: States have various policies regarding a physician's ability or responsibility to report at-risk drivers with dementia to the Department of Motor Vehicles (DMV). Some states have mandatory reporting policies, others have optional reporting policies and some have no policy regarding this issue. Arkansas has no reporting policy regarding drivers with dementia to the DMV. Therefore, physicians in Arkansas face the risk of liability if they report a patient against their will to the DMV in good faith. Neurologists and geriatricians are often in a position to diagnose and treat individuals with dementia. Research Questions: The following three research questions …

Chronic Physical Health Conditions Among Homeless, Nooshin Nikoo, Marjan Motamed, Mohammad Ali Nikoo, Verena Strehlau, Erika Neilson, Sahoo Saddicha, Michael Krausz

Journal of Health Disparities Research and Practice

ABSTRACT

Objective: Morbidity and mortality among homeless individuals is higher than the general population. This study aims to determine the prevalence of current self-reported, chronic physical health conditions in a large sample of homeless people with sub-samples from shelters and street in British Columbia, Canada. Methods: Cross-sectional survey applying modified version of the ‘National Survey of Homeless Assistance Providers and Clients (NSHAPC)’ questionnaire in multiple sites in Vancouver, Victoria and Prince George, British Columbia, Canada. Sample: Five hundred homeless individuals were surveyed between May and September of 2009. A person was defined as homeless if he/she had a …

Strengthening The Detection Of And Early Response To Public Health Emergencies: Lessons From The West African Ebola Epidemic, Mark J. Siedner, Lawrence O. Gostin, Hilarie H. Cranmer, John D. Kraemer

Georgetown Law Faculty Publications and Other Works

Background

In the year since the World Health Organization (WHO) notified of an Ebola outbreak in West Africa, more than 24,000 cases have been reported and over 10,000 individuals have died. Moreover, countless non-Ebola deaths have occurred as a result of health system closings and an international aid effort in the $USD billions has been invested in control efforts. While the international response to the West African Ebola virus disease epidemic eventually exemplified the great potential of the global public health community, the protracted early response also revealed critical gaps, which likely resulted in exacerbation of the epidemic. It is …

Law, Ethics, And Public Health In The Vaccination Debates: Politics Of The Measles Outbreak, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

The measles outbreak of early 2015 is symptomatic of a larger societal problem–the growing number of parents who decide against vaccinating their children. This failure is causing the resurgence of childhood diseases once eliminated from the United States.

This article explores the legal and ethical landscape of vaccine exemptions. While all states require childhood vaccinations, they differ significantly in the types of religious and/or philosophical exemptions permitted, the rigor of the application process, and available review mechanisms. States with relaxed exemption policies disproportionately experience more outbreaks of vaccine-preventable disease.

Vaccine exemptions are an illustration of the “tragedy of the commons,” …

Target Zero: Why States Choose To Eradicate Infectious Diseases And How They Succeed, Gifty Abraham

Dissertations, Theses, and Capstone Projects

Realism has remained the dominant paradigm within international relations for most of the modern era, emphasizing the competitive nature of the international arena and the unlikeliness of states to within it to cooperate. The attempts and further still, successes, by states to eradicate infectious diseases--which remain among the most cooperative enterprises--present a number of challenges to realism's assumptions, particularly with respect to the unlikely world historical-times during which the eradication campaigns took place. As such, a two-part puzzle arises. First, why would states, which are natural competitors, cooperate to eradicate infectious diseases given structural and situational incentives not to do …

Improving The Experiences Of Informal And Formal Alzheimer's Disease And Dementias Caregivers, Roxroy Anthony Reid

Walden Dissertations and Doctoral Studies

Informal and formal caregivers of persons with Alzheimer's disease and related dementias (ADRD) encounter a more difficult and unique set of challenges than do caregivers of individuals with general disabilities. If adequate caregiver supports are not provided, caregivers may experience increased strain as the disease progresses, increasing the likelihood of unnecessary institutionalization of their care recipients and increasing the cost to the public. Using rational choice theory and political systems theory, the purpose of this study was to differentiate between the phenomenological experiences of formal and informal caregivers of ADRD patients. The overall research was a qualitative design that used …

Providers' Knowledge Of The U.S. Health Care System And Their Medical Practice Choices: A Study Of Physicians, Residents, And Non-Physician Practitioners, Cora Case

Walden Dissertations and Doctoral Studies

The expansion of health insurance through health care reform has reduced the number of uninsured. but access to providers has not been addressed. Understanding the relationship between practice choices and aptitude of health policy and delivery is essential to determine other factors or motivators that contribute to the development of health care access policies. This descriptive study explored the value-laden elements of health care reform, such as social constructions, to learn whether there are implicit ways to address the issue of access to health care in the United States. Schneider and Ingrams's conceptualization of policy making through social construction was …

Marketplace Clinics Complementing Community-Based Diabetes Care For Urban Residing American Indians, Robert Steven Rick

Walden Dissertations and Doctoral Studies

The American Indians population in Minneapolis, Minnesota has experienced limited health care access and threefold diabetes health disparity. The purpose of this study was to measure the extent to which collaborating marketplace clinics and community-based support groups expanded diabetes care and provided self-management education for this largely urban Indian neighborhood. The marketplace clinics located in nearby CVS, Walmart, Target, and Supervalu stores committed financial support, certified educators, and pharmacy staff for the community-based support group. The study was conducted within the patient activation measure (PAM) analytical framework to assess the participants' acquired knowledge, skills, and confidence for diabetes self-management. A …

Food Policy: Urban Farming As A Supplemental Food Source, Bessie Didomenica

Walden Dissertations and Doctoral Studies

The distance between farms and cities and the limited access that some residents have to fresh foods can be detrimental to a city's capacity to feed people over time. This study addressed the under-studied topic of urban farming as a secondary food source, specifically by exploring the opportunities and limitations of urban farming in a large Northeastern city. Brundtland's food policy was the pivotal theory supporting food production to end global starvation, and was the link between environmental conservation and human survival. The research question for this study examined the potential food policy opportunities and limitations that assist urban farms …

Health Care Reform And The Transition From Volume To Quality Payment Models: A Primary Care Focus, Kevin Lee Jackson

Walden Dissertations and Doctoral Studies

The 2010 Patient Protection and Affordable Care Act (PPACA) resulted in providers and health care organizations conforming to new payment models that connect reimbursement to patient outcomes. Primary care providers (PCPs) are tasked to provide new quality provisions as chronic disease management is a key focus to improve outcomes. The purpose of this study was to understand the transition to new payment models and determine whether care is improved. The conceptual framework is grounded in health care access models geared towards the improvement of quality outcomes including the chronic care model (CCM). The research questions were designed to understand providers' …

A Comparison Of Regional Health Care Structures For Emergency Preparedness, Leslie Porth

Walden Dissertations and Doctoral Studies

Since 2001, increased policy attention and federal funding mechanisms have required more effective disaster response by government actors and private sector organizations, including the health care system. However, there is limited scholarly evidence documenting which structural elements have been associated with efficacious regional coalitions. This study addressed the gap by examining whether the number of different participating disciplines (a proxy for coalition roles), community setting, and prior weather-related disaster declaration influenced the number of activities (a proxy for coalition responsibilities) conducted by the health care coalition. Social network theory was the theoretical lens with which the study results were used …

Perceived Factors Contributing To Coronary Heart Disease In African American Women, Funmilola O. Sholanke

Walden Dissertations and Doctoral Studies

African American women (AAW) suffer from disproportionately high death rates due to coronary heart disease (CHD) compared to Caucasian women. Although there have been a number of studies targeting African American adults with CHD in clinical interventions, very few studies have addressed the social determinants of health and the influence of AAW's perceptions of health factors on health outcomes. The purpose of this phenomenological study was to fill the gap in the existing knowledge base by examining the lived experiences of 10 AAW diagnosed with CHD with a focus on the perceptions of environmental, socioeconomic, and cultural factors related to …

Supplemental Nutrition Assistance Program And Home Food Availability : The Role Of Depression And Household Characteristics, Marta D. Hernandez

Legacy Theses & Dissertations (2009 - 2024)

Although about 47 million low-income people participated in the Supplemental Nutritional Assistance Program (SNAP) program at the end of 2012, the effect of SNAP participation on some nutrition related outcomes is controversial or unknown. Particularly, the effect of SNAP on food availability at-home has not been examined despite its association with food consumption. In addition, little is known about individual and social factors influencing this relationship. This study examined the effects of the interaction between SNAP participation and depression and the effects of the interaction between SNAP participation and the presence of children under 17 years of age on food …

The Relationship Between Hospital Safety Culture And Variation In Adverse Events : What Is The Evidence From Nys Hospitals?, Kathleen Ciccone

Legacy Theses & Dissertations (2009 - 2024)

Background: There is widespread acknowledgement that patients often suffer from adverse events that occur in the provision of medical care (Leape et al., 1991; Kohn et al., 2000). A notable percentage of these events stem from poor practices and unreliable hospital safety systems (Leape et al., 1991; Kohn et al., 2000; Chassin, 2013). Although the literature has been mixed regarding the association between perception of safety culture in hospitals and rates of adverse events, policy makers and healthcare thought-leaders have called on hospital leadership to improve safety culture as one strategy for decreasing harm to patients.

The Impact Of Disability: A Comparative Approach To Medical Resource Allocation In Public Health Emergencies, Katie Hanschke, Leslie E. Wolf, Wendy F. Hensel

Faculty Publications By Year

It is a matter of time before the next widespread pandemic or natural disaster hits the United States (U.S.). The international response to the 2009 H1N1 influenza stands as a cautionary tale about how prepared the world is for such an emergency. Although the pandemic fortunately proved to be less severe than initially anticipated, it nevertheless resulted in shortages of medical equipment, overburdened hospitals, and preventable patient deaths, particularly among young people.

A pandemic will inevitably lead to difficult decisions about the allocation of medical resources, such as who will have priority access to ventilators and critical care beds when …

Toward Coherent Federal Oversight Of Medicine, Patricia J. Zettler

Faculty Publications By Year

The conventional wisdom in U.S. health law and policy holds that states regulate medical practice – the activities of physicians and other health care professionals – while the federal government regulates medical products. But relying on states as the principal regulators of medical practice has, at times, driven law and policy in directions that are problematic from a public health perspective, as demonstrated by a deadly 2012 outbreak of fungal meningitis that was linked to a state-regulated practice known as drug compounding. This Article argues that the federalism concerns underlying the conventional wisdom are misplaced. It demonstrates that, contrary to …

Relationship Between Modality And The Degree Of Knowledge Retention In Bioterrorism Training, Gaylon Rashun Crawford

Walden Dissertations and Doctoral Studies

A public health workforce must be trained to react quickly, especially in the case of terrorist attack. Political leaders and emergency management experts have often cited inadequate emergency training as a contributing factor in the public health system's failed preparations for a bioterrorist event. As a result of these failures, billions of dollars have been allocated towards correcting infrastructure deficiencies including training for public health nurses (PHNs), who are critical to a communitywide medical response. This quantitative study used Pearson's correlation and a multivariate regression analysis to evaluate the most effective modality of bioterrorism training (BTT) for PHNs working in …

Differences Between For-Profit And Nonprofit Hospitals: Perceived Quality And Access, Michael Ray Eiland

Walden Dissertations and Doctoral Studies

Despite a large body of literature addressing the issue, questions remain about whether nonprofit hospitals provide more community benefit than do for-profit hospitals. This lack of information impacts governments, hospitals, and the healthcare industry, as stakeholders attempt to generate requirements to which hospitals should adhere to maintain nonprofit status, and thus tax exemption. This study addressed this lack of information by examining U.S. hospitals through the lens of stewardship theory to determine whether nonprofits are better stewards of the public good than for-profits, and thus likely to provide higher quality and access. The study applied logistic regression to Centers for …

Knowledge Of Overdiagnosis And The Decision To Participate In Breast Cancer Screening, Kimberly T. Nembhard

Walden Dissertations and Doctoral Studies

In 2014, breast cancer was the second leading cause of death among Canadian women, with women over age 50 years making up 82% of the identified cases. To address this issue, the Ontario Breast Screening Program developed a media campaign that promoted the benefits of mammogram screening, but not the associated risks (i.e., false-positive, false-negative, radiation exposure, and overdiagnosis). This study was designed to determine whether there was a statistically significant relationship between knowledge of overdiagnosis and participation in mammogram screening. This cross-sectional, correlational study used schema theory supported by the effective health communication model. Forty-one women were invited to …

Retaining Behavioral Healthcare Employees Of The Millennial Generation, David W. Gomel

Walden Dissertations and Doctoral Studies

As a result of the passage of the Affordable Care Act, the behavioral healthcare field is experiencing an increased demand for services. This increase is based on the availability of healthcare coverage to an estimated 13.4 million previously uninsured individuals. To meet this demand for treatment, the workforce of behavioral health therapists must grow. The largest generation entering the workforce, the Millennial Generation - those born after 1980 - is believed to lack commitment to their employers, frequently vacating their positions for the next best offer. The purpose of this case study was to determine factors that both affect retention …

The Association Between Asthma Management And Routine Posture Exercise, Anne-Marie Lydie Coleman

Walden Dissertations and Doctoral Studies

Asthma cannot be cured, but it can be managed. Asthma management is a public health issue that is complex. Medication, asthma triggers, age, and the environment are all factors that impact asthma management. There is a gap in research in terms of what lifestyle characteristics need to be in place in order for adults to manage asthma. Shaw found that posture care is a lifestyle variable that should be explored as it relates to asthma management in older adults. The Life University Clinic (Marietta, GA) sees asthmatic patients daily and teaches them about a posture care routine through a program …

An O'Neill Institute Briefing Paper: Ebola, The World Health Organization, And Beyond: Toward A Framework For Global Health Security, Lawrence O. Gostin, Eric A. Friedman, Daniel Hougendobler

Georgetown Law Faculty Publications and Other Works

The West African Ebola epidemic has demonstrated that the world remains ill-prepared to respond to infectious disease outbreaks. A host of institutions are now reviewing what went wrong, and new institutions are being considered, including an African Centers for Disease Control and Prevention and World Bank-initiated Pandemic Emergency Facility. The World Health Organization itself failed in one of its core functions by allowing a preventable infectious disease to spiral out of control in the world’s poorest region. The 68th World Health Assembly (WHA), held in May 2015, provided an opportunity for the Organization to reflect on what went wrong and …