Health Policy Commons^™

How Is Food Insecurity Measured In The United States And What Share Of Older Adults Are Food Insecure?, Colleen M. Heflin, Madonna Harrington Meyer

Population Health Research Brief Series

The U.S. Department of Agriculture measures food insecurity based on whether households had problems affording food during the last twelve months. Based on the current definition, in 2023 9.2% of households with adults ages 60 and older were food insecure. But there are many problems with the existing definition for accurately capturing food insecurity among older adults.

Based on the book, Food for Thought: Understanding Older Adults Food Insecurity, this brief summarizes those limitations, noting that existing measures do not account for barriers that are common among older adults, such as mobility, physical distance, and transportation barriers.

African Swine Fever In Indonesia: Insights From Southeast Asia’S Policy Response Through The One Health Approach, Niken Salindri, Wachyu Sulistiadi

Journal of Indonesian Health Policy and Administration

African Swine Fever (ASF) seriously threatens pig production systems, food security, and rural livelihoods across Southeast Asia. This study employs an analysis of secondary national data from Indonesia using a quantitative descriptive analysis approach, complemented by regional policy responses to ASF from 2019 to 2024. To contextualize regional findings, this study also integrates official statistics from Statistics Indonesia (BPS) covering provincial pork production trends (2021–2023), the number of ASF-affected pigs per province (2020–2024), and per capita pork consumption by district. Quantitative data show that ASF outbreaks have been disproportionately concentrated in specific provinces such as East Nusa Tenggara and North …

The Effects Of Input And Characteristic Factors On Contact Rate Achievement Among Puskesmas In Indonesia, Iqbal Andri Makarim, Pujiyanto Pujiyanto

Journal of Indonesian Health Policy and Administration

The contact rate is the lowest-performing indicator in the Performance-Based Capitation Payment system initiated by BPJS Kesehatan. Analysis of the 2019 National Health Facility Research (Rifaskes) data showed that less than half of Puskesmas in Indonesia achieved the target. This cross-sectional study analyzed 5,384 Puskesmas from the 2019 Rifaskes to examine the effect of input and characteristic factors on achieving the contact rate. Independent variables included health worker ratios (doctors, nurses, midwives per 5,000 participants), completeness of essential medical equipment, communication facilities, P-Care application use, and Puskesmas characteristics. Multivariate logistic regression identified four significant factors: doctor ratio (OR=1.06; p<0.0001), midwife ratio (OR=1.01; p=0.033), completeness of essential medical equipment (OR=1.16; p=0.029), and BLUD-based financial management (OR=1.13; p=0.029). These factors explained only 2.6% of the variance (Nagelkerke R²=0.026), suggesting other unmeasured influences. Policy implications include equitable distribution of health personnel, targeted procurement of essential equipment, strengthening financial autonomy through BLUD, and optimizing P-Care data utilization to improve service accessibility and performance.

Overview Of A Hospital Management Information System Using The Hot-Fit Method In Medan Hospitals In 2025, Grace Putri Laia, Hotmarina Lumban Gaol, Jev Boris

Journal of Indonesian Health Policy and Administration

Hospital Management Information System (SIMRS/HMIS) is crucial in ensuring efficiency and quality in hospital services by integrating clinical and administrative functions. This study aims to evaluate the implementation of HMIS at Medan Adventist Hospital in 2025 using the Human-Organization-Technology Fit (HOT-Fit) framework. A descriptive design with total sampling was employed, involving 70 respondents comprising medical records staff, inpatient and outpatient registration staff, and ward officers. Data were collected through a structured questionnaire adapted from a validated instrument (validity 0.690–0.900; reliability 0.841–0.911) and analyzed using descriptive statistics. The results showed a high level of implementation in all HOT-Fit domains: system use …

The Ethics Of Clinical Ethics, Matthew Shea

Center for Medical Ethics and Health Policy Staff Publications

The concept ethics defines health care ethics as a professional practice. Yet the meaning of "ethics" is often unclear in the theory and practice of clinical ethics. Clarity on this matter is crucial for understanding the nature of clinical ethics and for debates about the professional identity and proper role of ethicists, the sort of training and skills they should possess, and whether they have ethics expertise. This article examines two different ways the ethics of clinical ethics can be understood: Real Ethics, which consists of objective moral norms grounded in moral truth; and Conventional Ethics, which consists of conventional …

Eugenics And Polygenic Embryo Screening: Public, Clinician, And Patient Perceptions Of Conditions Versus Traits, Dorit Barlevy, Rémy A Furrer, Asha Kalapatapu, Abigail Martinez, Todd Lencz, Shai Carmi, Gabriel Lázaro-Muñoz, Stacey Pereira

Center for Medical Ethics and Health Policy Staff Publications

Purpose: Polygenic embryo screening (PES) estimates an embryo's genetic chances of developing complex conditions (eg, cancer) and traits (eg, height). Stakeholders have raised concerns that PES promotes eugenic practices and ideology.

Methods: We surveyed a nationally representative sample of the US public on approval of screening embryos for 12 conditions and 12 traits and examined the association between disapproval and concern about eugenics. We also conducted semistructured interviews with US-based reproductive endocrinology and infertility specialists and patients undergoing in vitro fertilization on their perspectives toward PES.

Results: Among the US public (n = 1423), disapproval of screening embryos for traits …

Towards A New Health Politics In Kenya: Labor Organizing And Strikes By Health Workers In The Public Health Sector, Michael Scanlon

Graduate Doctoral Dissertations

There has been insufficient attention by global health scholars to labor organizing by health workers, including when and why organizing occurs, what forms and strategies it takes and its implications for governance and policy. These questions are critical but largely absent in research on what has been called the “global health workforce crisis.” Kenya represents an important case study. A new constitution in 2010 expanded institutional spaces for labor organizing and decentralized governance of the health system. Both reforms had significant implications for the health workforce and strikes by health workers have been pervasive. In 2017, nationwide strikes by public …

Has Regional Hospital Autonomy Achieved Its Goals? Lessons Learned From Indonesia: A Systematic Review, Masyitoh Basabih, Indriaswari Widhakuswara

Kesmas

This study examined the impact of hospital autonomy implementation on the performance of regional public hospitals in Indonesia, particularly in terms of efficiency, effectiveness, and governance. A systematic review of 32 peer-reviewed studies published between June 12 and September 6, 2023, was conducted using Garba Rujukan Digital and Google Scholar, following PRISMA guidelines. Studies addressing financial performance, service outcomes, and challenges related to implementing autonomy were included. The findings indicated that while autonomy led to improvements in infrastructure, service types, visit volumes, and hospital revenues, it had only a marginal impact on improving key health performance outcomes, such as service …

Experiences Of Elderly Living With Noncommunicable Diseases In Utilizing Health Services In Myanmar During The Covid-19 Pandemic, Nway Eint Chei, Kwanjai Amnatsatsue, Natkamol Chansatitporn, Ariya Bunngamchairat

Kesmas

The COVID-19 pandemic and armed conflicts in Myanmar have intensified the challenges in accessing and utilizing health services, particularly for noncommunicable diseases (NCDs) among older adults. This qualitative study explored the experiences of the elderly with NCDs regarding health service accessibility and utilization in secure areas with fully operational health facilities by conducting in-depth interviews with 20 eligible older adults in Myanmar; data were analyzed using content analysis. Four key themes emerged: NCD service utilization patterns; unmet needs; preferences and hesitancy toward NCD services; and disparities, barriers, and opportunities. The findings revealed widespread underutilization of NCD services due to several …

Government Health Spending And Life Expectancy: Evidence From Cities And Districts In Indonesia, Kurnia Sari, Budi Hidayat, Amal Chalik Sjaaf, Mardiati Nadjib

Kesmas

Life expectancy is widely recognized as a fundamental indicator of population health, and its improvement is often linked to government health spending, particularly in decentralized health systems. This study aimed to investigate the relationship between local government health expenditures and life expectancy in decentralized Indonesia. Data from 492 cities and districts, spanning from 2015 to 2019, were analyzed using a two-way fixed effects regression model to control for time-invariant district characteristics and common temporal shocks. The findings indicated that a 10% increase per capita in government health expenditure was associated with a 0.01% increase in life expectancy. This association was …

Barriers To Implementing Comprehensive Sexuality Education As A Strategy To Prevent Adolescent Pregnancy In Indramayu District, Indonesia, Een Kurnaesih, Chahya Kharin Herbawani, Nelly Febriani

Kesmas

The implementation of comprehensive sexuality education (CSE) is not optimal. This qualitative study aimed to identify and contextualize barriers to CSE implementation, specifically in Indramayu District, Indonesia. Conventional content analysis procedures were used. Seven participants, consisting of relevant authorities, were interviewed. A purposive sampling technique was employed to select participants. Data were collected through in-depth, semi-structured interviews. All interviews were recorded and transcribed verbatim. Data were analyzed using conventional qualitative content analysis. The barriers to CSE implementation in Indramayu District were identified across five themes: advocacy, technical considerations, coordination and collaboration, integration with other sexual and reproductive health projects, and …

Governance Of Polygenic Embryo Screening: A Qualitative Study On The Perspectives Of Clinicians And Patients, Jason Bach, Jonathan Frumovitz, Dorit Barlevy, Rémy A Furrer, Abigail Martinez, Ana Battaglino, Shai Carmi, Todd Lencz, Gabriel Lázaro-Muñoz, Stacey Pereira

Center for Medical Ethics and Health Policy Staff Publications

Objective: To investigate the perspectives of stakeholders on their attitudes toward potential regulation of polygenic embryo screening (PES), a new form of preimplantation genetic testing that is used to screen embryos for the genetic chances of developing medical conditions and nonmedical traits involving hundreds or thousands of genes.

Design: We conducted individual, semistructured interviews and analyzed transcripts using thematic analysis.

Subjects: Twenty-seven US-based reproductive endocrinology and infertility specialists and 26 patients who were currently undergoing in vitro fertilization or had within the past five years.

Main outcome measures: Repeating ideas and patterned responses were organized into themes and subthemes.

Results: …

Time Ticks Slowly For Kidney Transplant Reform: Eskd Patient Challenges And Opportunities, Gregory P. Hess

College of Population Health Faculty Papers

No abstract provided.

Factors Associated With Adolescents' Self-Efficacy To Meet With Their Health Care Provider Alone, Albert C Hergenroeder, Blanca Sanchez-Fournier, Cassandra Enzler, Mary Majumder, Beth H Garland, Constance M Wiemann

Center for Medical Ethics and Health Policy Staff Publications

Adolescents with special health care needs (ASHCNs) must develop self-management skills to effectively transition into adult-based care. This requires having the self-efficacy to meet with their health care provider independent of caregivers. This study aims to identify the factors associated with self-efficacy in meeting with a provider alone among ASHCN preparing for this transition.Eighty-three English-speaking 18-year olds with renal, gastrointestinal, neurologic, or rheumatologic diseases, and their English- or Spanish-speaking caregivers were recruited at a large children's hospital, and completed a one-time assessment as the historical control group for a larger intervention study. The main outcome measure was self-efficacy to meet …

Nevada Medical Residencies, 2025, Olivia K. Cheche, Caitlin J. Saladino, William E. Brown Jr.

Health

This fact sheet highlights medical residency data for the 2021, 2022, 2023, 2024, and 2025 graduating classes of the Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas (UNLV) and the University of Nevada, Reno (UNR) School of Medicine. This fact sheet presents data on residency program matches at the Kirk Kerkorian School of Medicine at UNLV and the UNR School of Medicine, shows where Nevada medical school graduates pursue their residencies, and updates findings from a 2024 fact sheet exploring 2021, 2022, 2023, and 2024 graduating class data.

Digital Transformation In Jamaica's Education Sector, Grace Willis

Capstone Collection

Digital transformation in Jamaica’s education sector, significantly spurred by the COVID-19 pandemic, represented a seismic shift on this small Caribbean island I call home. This transformation was central to national education reform and involved multiple projects aimed at modernizing educational delivery, infrastructure, and the supporting ecosystem. This study explored the multifaceted implications of these initiatives through qualitative research conducted with ten key stakeholders, complemented by a review of publicly available materials. Interviewees included school administrators, Information Technology (IT) teachers, funding sponsors, representatives from national education bodies, and international development agencies engaged in domestic strategic efforts. Participants were recruited through cold …

Snap Benefits In A Recession: Mountain West State Projections, Olivia K. Cheche, Caitlin J. Saladino, William E. Brown Jr.

Health

This fact sheet presents data on simulated recession impacts to the Supplemental Nutrition Assistance Program (SNAP) in the Mountain West. The Urban Institute’s “How Would a State Cost Share Affect SNAP in a Recession?” report provides recession projections based on the current SNAP policy – which allows SNAP to automatically expand in the event of a recession – as well as a 10% cost share scenario, for all 50 U.S. states and the District of Columbia. This fact sheet focuses on recession projections for the five Mountain West states of Arizona, Colorado, Nevada, New Mexico, and Utah.

Resilience Of Interdependent Transportation And Healthcare Systems: A Simulation-Driven Framework Incorporating Social Equity And Facility Optimization, S. Yasaman Ahmadi

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

The overarching goal of this dissertation is to develop an integrated, simulation-driven framework to assess and enhance the resilience of interdependent transportation and healthcare systems before, during, and after natural hazards. By examining how spatial disruptions, social vulnerability, operational constraints, and infrastructure interdependencies affect access to and functionality of hospitals, this research offers a multifaceted evaluation of system performance under stress. This dissertation examines the impact of natural hazards, particularly floods, on the interdependent transportation and healthcare systems. The proposed approach combines and advances GIS-based network analysis, graph-theoretical modeling, and discrete-event simulation to evaluate system performance under different scenarios. The …

Framing The Problem To Meet The Policy Solution: An Embedded Mixed Methods Case Study Of The 2017 Michigan Opioid Laws, Leandra Hawkins Burke

Dissertations

The opioid crisis presents a wicked problem for public administration. Hundreds of thousands of people have died from opioid overdoses in the United States, and countless others have experienced severe opioid-related physical, psychological, and socioeconomic harms. Countering the opioid crisis has been difficult due to interdependencies across different drugs and multiple pathways for abuse and dependence. Many scholars, health providers, and politicians have called for a broad public health approach to combat the opioid crisis, but the full expanse of what that would entail has not yet been realized. What has been demonstrated is that interactions targeting a single aspect …

Institutional Betrayal And Military Vaccine Mandates: An Inquiry Into Loss Of Health Autonomy Concerning Unlimited Liability Contractual Employment In The Covid-19 Era, Aaron G. Dehaven

Electronic Theses and Dissertations

The balance between government control and personal liberty is a growing concern in the modern world. Nowhere is this more evident than in discussions surrounding government policy in public health and individual health autonomy. The Covid-19 pandemic forced many institutions to change their standard operating procedures by adapting to rapidly changing health guidance instituted to protect public health. These changes highlighted the role of health autonomy and individuals’ rights to refuse medical treatments. The Department of Defense changed many aspects of how it operated during the pandemic, including the mandate of the Covid-19 vaccine for all service members. For various …