Health Policy Commons^™

Community Health Centers And Medicaid Payment Reform: Emerging Lessons From Medicaid Expansion States, Peter Shin, Jessica Sharac, Zoe Barber, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Community health centers represent a major source of primary health care for the nation’s Medicaid beneficiaries. Because the Federally Qualified Health Center (FQHC) payment system is encounter-based, health centers and Medicaid agencies in ACA expansion states are actively pursuing payment reforms that will enable health centers to adopt strategies that can more effectively respond to the considerable and complex health and social needs of people served by health centers, and more efficiently address the surging volume of patient care. In five expansion states whose alternative payment experiments are underway, health centers and Medicaid agencies are testing payment alternatives, such as …

Grassroots Community Fundraising And Advocacy To Reduce Breast Cancer Mortality In Ohio Through Patient Navigation And Safety-Net Programs, Julie Mcmahon

Learning Showcase 2016: A Celebration of Discovery, Transformation and Success

Ohio has the third highest breast cancer mortality rate of any state in the U.S. In 2016, 1,700 women will die from breast cancer in Ohio. When diagnosed at early stages, survival and quality of life are improved. Barriers to care like finances, health literacy, insurance coverage, fear and transportation contribute to late-stage diagnoses. A community needs assessment of 30 counties in central and southeast Ohio was conducted to inventory all health system assets, healthy policy impacts, and collect qualitative data to identify local barriers and solutions to reduce mortality. Results were used to develop a multi-level approach to reduce …

Syrian Refugee Women In Jordan: Family Planning Preferences And Barriers In A Host Community, Hilary Smith

Independent Study Project (ISP) Collection

The aims of this pilot study were to research and analyze the availability of birth control and family planning resources among Syrian refugee women at a reproductive age. This study took place in the host community of Karak, Jordan. Syrian women are a vulnerable population based solely on their gender. But being refugee women makes them more vulnerable and sometimes, their needs do not get met. This study is important because it will look into reproductive health aspects for this vulnerable population to ensure that there is satisfaction among women about their own health. This cross-sectional study sought to answer …

Health Departments’ Engagement In Emergency Preparedness Activities: The Influence Of Health Informatics Capacity, Gulzar H. Shah, Bobbie J. Newell, Ruth E. Whitworth

Health Policy & Management: Faculty Publications (2006-2018)

Background: Local health departments (LHDs) operate in a complex and dynamic public health landscape, with changing demands on their emergency response capacities. Informatics capacities might play an instrumental role in aiding LHDs emergency preparedness. This study aimed to explore the extent to which LHDs’ informatics capacities are associated with their activity level in emergency preparedness and to identify which health informatics capacities are associated with improved emergency preparedness.

Methods: We used the 2013 National Profile of LHDs study to perform Poisson regression of emergency preparedness activities.

Results: Only 38.3% of LHDs participated in full-scale exercises or drills for an emergency …

Social Learning Through Stakeholder Engagement: New Pathways From Parcipitation To Health Equity In U.S. West Coast Hia, Nicole Iroz-Elardo, Moriah Mcsharry Mcgrath

Urban Studies and Planning Faculty Publications and Presentations

While some contend that extensive public engagement activities are necessary to meet Health Impact Assessment (HIA) practice standards, other work suggests that an HIA of any type hasthe potential to inform decision-making in ways that embody HIA’s value of democracy (Cole & Fielding, 2007; Harris-Roxas et al., 2012; Negev, 2012). These divergent perspectives on how to realize democracy through public participation represents an area of evolving debate in the ongoing development of HIA practice in the US. Looking to the relatively diverse HIA practice on the west coast of the US, we explore the interplay between engagement strategies and HIA …

Health Insurance Co-Ops: Product Availability And Premiums In Rural Counties, Erika C. Ziller Phd, Zachariah T. Croll Ba, Andrew F. Coburn Phd

Access / Insurance

Created by the Affordable Care Act (ACA), Consumer Operated and Oriented Plans (CO-OPs) are private, non-profit health insurers that were designed to increase insurance plan choice and lower premiums in the Health Insurance Marketplaces. Early analyses of the ACA suggested that CO-OPs may be particularly beneficial for rural communities, where fewer individual and small group health insurance options have traditionally been available.

This Research and Policy Brief, authored by research staff at the Maine Rural Health Research Center, explores the early availability and role of CO-OPs in rural and urban counties. We describe the regional distribution and market prevalence of …

The Associations Between Environmental Quality And Mortality In The Contiguous United States, 2000-2005, Yun Jian, Lynne C. Messer, Jyotsna S. Jagai, Kristen M. Rappazzo, Christine L. Gray, Shannon C. Grabich, Danelle T. Lobdell

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Assessing cumulative effects of the multiple environmental factors influencing mortality remains a challenging task.

Objectives: This study aimed to examine the associations between cumulative environmental quality and all-cause and leading cause-specific (heart disease, cancer, and stroke) mortality rates.

Methods: We used the overall Environmental Quality Index (EQI) and its five domain indices (air, water, land, built and sociodemographic) to represent environmental exposure. Associations between the EQI and mortality rates (CDC WONDER) for counties in the contiguous United States (n=3109) were investigated using multiple linear regression models, and random intercept, random slope hierarchical models. Urbanicity, climate and their combination were …

The Road Into The Future Of Health Care: The Importance Of Addressing Access To Health Facilities In Transportation Infrastructure Investment Decisions, Nicola (Nikki) Van Den Heever

Independent Study Project (ISP) Collection

Background: One school of thought argues that transportation infrastructure is not an ultimate end goal of development and therefore shouldn’t be addressed within development funding decisions while the other argues that transportation infrastructure is the crucial foundation from which all development efforts are based and therefore needs to be addressed within development funding decisions. Within this framework, there is a lack of academic and other research addressing how physical access to health care for pregnant women can better be addressed when making decisions regarding funding of transportation infrastructure projects.

Purpose: To demonstrate the importance of considering access to health care …

Emergency Medical Services And Public Policy In Durban, Kwazulu-Natal, John Buyske

Independent Study Project (ISP) Collection

This project seeks to explore the realities of the emergency medical system in the Durban area, particularly relative to government policy. It contextualizes its findings within the literature on public policy. Data for the project was collected via nine in-depth interviews with various professionals working in the field of emergency medical services, as well as a survey of fourteen citizens conducted in the peri-urban township of Cato Manor. This data was analyzed using qualitative methods. While every participant had different views and a different perspective on emergency services, some recurring themes and trends became evident, allowing for conclusions to be …

A Preliminary Study Of Intergenerational Differences In Masxha Regarding Practice And Attitudes Towards Zulu Traditions During Pregnancy And Birth, Momoko Oyama

Independent Study Project (ISP) Collection

In the Zulu culture, several traditions and rituals are practiced during a woman’s pregnancy and perinatal period. However, as urbanization spreads and western influences strengthen, these rituals risk being lost. This project aims to capture existing knowledge of these traditions and to assess the intergenerational changes in practice and attitudes towards practicing the rituals.

Information on Zulu traditions practiced during a woman’s pregnancy and perinatal period was collected through two interviews and a focus group consisting of three elderly women in Masxha, a Black township in KwaZulu-Natal. Following the interviews and focus group, 32 Masxha residents were recruited to complete …

Access Is Not Enough: Family Planning In Dar Es Salaam, Claire Burrus

Independent Study Project (ISP) Collection

Population growth is a large problem, both globally and at local levels. The global population is growing at an unsustainable rate, particularly in developing nations. Tanzania, as a developing nation, is one of the fastest growing countries in the world, and as a result, faces many hardships related to high population. The Tanzanian government, non-governmental organizations, and private institutions have made attempts to address these concerns by encouraging family planning. Even so, the national population continues to rise. Many social and cultural factors have contributed to this phenomenon. This study was performed in the Women’s Clinic at Sanitas Hospital in …

Continuous Care In Complex Contexts: Access To Health Services For Noncommunicable Diseases Among Syrian Refugee Women In Jordanian Host Communities, Jennifer Ostrowski

Independent Study Project (ISP) Collection

This study examines how, when and where Syrian refugee women living in a host community in central Jordan access health services related to noncommunicable diseases. Noncommunicable diseases are the leading cause of death and disability worldwide, but can be effectively managed through timely treatment. Examining access to care for these diseases in the context of humanitarian emergencies, such as war and displacement, is particularly important because they require continuous care, which may be interrupted during emergencies, and because they can cause acute complications, which may be exacerbated by emergencies (WHO, 2016).

Previous studies indicate a high burden of NCDs among …

“Always A Double-Edged Sword”: How Women And Health Care Providers Navigate Issues Of Contraception In Differing Senegalese Communities, Angelina Strohbach

Independent Study Project (ISP) Collection

This paper examines how women and health care providers in two distinct Senegalese settings—Dakar and Mouit, a village located within the Gandiol region-- navigate contraception as both a social and medical good. Contraception is an invaluable tool in terms of advancing women’s right to reproductive health, but major discrepancies in its usage exist across a variety of social lines in Senegal, including level of education, marital status, occupation, age, and living in a rural versus urban setting. What socially constructed thought processes and lived experiences contribute to these discrepancies? In a cultural context heavily based upon tradition and Islamic faith, …

Exploring Access To Portable Water And Sanitation Practices In A Post-Conflict Environment: The Case Of Gulu District, Northern Uganda, Peyton Going

Independent Study Project (ISP) Collection

Over the course of 30 days of fieldwork in October and November of 2016, data was collected through interviews conducted with local government officials, researchers and academics, and village community members of Gulu District.

The aim of this study was to determine the extent to which agencies have improved water and sanitation in the region. The case study of Gulu utilized in-depth interviews with key informants, focus groups, and observations, and sought to determine who the local stakeholders in water and sanitation are, the water sources and sanitation facilities available and their uses, the perception local people have about their …

Multi-Sector Analysis Of The Progress And Challenges Of Soil-Transmitted Helminth Eradication In Rural Udaipur, Jessica Ellis

Independent Study Project (ISP) Collection

India is home to 240 million children currently at risk of Soil-Transmitted Helminthiasis, which is spread via unclean water, soil, and food, and causes acute pain and malnutrition. While acknowledging the research debates over WASH and mass drug administration, this study seeks to identify the systemic multidisciplinary issues affecting STH elimination efforts in rural Udaipur. Twenty-three interviews were conducted in villages, government departments, NGOs, and medical sectors to identify the challenges within each approach to deworming, and their experiences with multi-sectoral collaboration. The most recurring issues across disciplines were need for invested local leadership, increase in health literacy of adults, …

Self-Perceptions Of Disability And Impairment In An Indian Prosthetic Population Using Jaipur Foot Technology, Litany Esguerra

Independent Study Project (ISP) Collection

Twenty-nine first time and repeat prosthetic users were interviewed over a period of three weeks to determine how they perceived their own disability at Bhagwan Mahaveer Viklang Sahayata Samiti, or Jaipur Foot, located in Jaipur, India. The questions delineated different aspects of people’s disabilities and impairment, and asked a multitude of questions regarding social, economic, political, and other contexts, influenced by the conceptual framework of the International Classification of Functioning (ICF). The study analyzed all of the factors as specified by the questionnaire and found that many varying trends over all types of prosthetic users. The study also used the …

Powerful Words: An Exploration Of Linguistic Hierarchy In Moroccan Hospitals, Ellelan Degife

Independent Study Project (ISP) Collection

Morocco is a country of distinct diversity, which exists as a result of the settling of multiple peoples and European colonization. As a result of this diversity, many languages are employed in different settings and spaces, and of these languages, French represents remnants of colonialism and continual elitism in the country. One of the spheres that French commands in Moroccan society is medicine, which creates a dichotomy between the educated health care providers and the underprivileged patients in public hospitals. The aim of this paper is to explore the effect of French on the doctor-patient relationship in urban, public Moroccan …

Dealing With Migratory Trauma: Mental Health Stressors And Coping Mechanisms Among Sub-Saharan Migrants In Rabat, Morocco, Dominique Defreece

Independent Study Project (ISP) Collection

Interviews, surveys, and participant observation was used to study the mental health of Sub-Saharan migrants residing in Rabat, Morocco. These data collection methods were used to explore the various experiences migrants had pre-migration, during their migration journey, and post-migration. The migrants portrayed many negative, traumatic, and painful experiences. These experiences have caused a significant amount of pressure on the mental psyche of the migrants, manifesting itself in many physical and psychological problems. One common problem was a sense of disillusionment or lack of control over their bodies and situations. However, many of them do not seek the help of mental …

A Case Study Of Individual And Organizational Stakeholder Perspectives On State Factors Impacting Access To Rural Health Care Services In Idaho, Molly Vaughan Prengaman

Nursing ETDs

The purpose of this case study was to describe individual and organizational perspectives on the state factors and political context impacting access to rural health care services in Idaho. Approximately 50 million Americans, roughly 20% of the United States population, live in rural areas (U.S. Census Bureau, 2012). For over 100 years, U.S. rural residents have experienced health disparities and health care access barriers (De Alessi & Pam, 2011). Rural residents evidence greater health risks, fewer health care providers, poorer health outcomes, and greater mortality than most urban residents (Jones, Parker, Ahearn, Mishra, & Variyam, 2009). Since many rural health …

Current Practices Of Obesity Pharmacotherapy, Bariatric Surgery Referral And Coding For Counselling By Healthcare Professionals, Christine Petrin, Scott Kahan, Monique Turner, C. Gallagher, William Dietz

Health Policy and Management Faculty Publications

Introduction

Rates of obesity pharmacotherapy use, bariatric surgery and intensive behavioural counselling have been extremely low.

Objectives

The primary objective of this study was to survey healthcare provider beliefs, practice and knowledge regarding obesity management.

Methods

Primary care physicians (PCPs), OB‐GYN physicians and nurse practitioners (NPs) responded to a web‐based survey related to drug therapy practice, bariatric surgery referral and reimbursement coding practice.

Results

Rates of reported use of obesity pharmacotherapy appear to be increasing among PCPs, which is likely related to the approval of four new obesity pharmacotherapy agents since 2012. Rates of pharmacotherapy use among OB‐GYNs and NPs …