Health Policy Commons^™

An Implementation Analysis Of Needle Exchange Programs In Kentucky: Implementation Barriers And Facilitators Identified By Stakeholders, Samantha Jane Harris

MPA/MPP/MPFM Capstone Projects

Kentucky law authorizes county health departments to implement harm reduction needle exchange programs given that the county receives approval from all governing authorities including the local and/or district boards of health, the county government, and the city government in the jurisdiction in which the exchange is intended to operate. As of April 2016, five county health departments operate needle exchange programs and around 20 other county health departments are seeking approval from their governing authorities or beginning to discuss engaging in this process.

I conducted qualitative interviews with key stakeholders in the implementation process to determine the facilitators and barriers …

Across The States: Do Long Term Services & Supports Policies Affect The Number Of Nursing Home Residents With Low-Care Needs?, Mary Otis

MPA/MPP/MPFM Capstone Projects

Long term care for the elderly has been steadily gaining salience in the public policy realm for many years. The federal government has been vigorously studying and exploring solutions, including the Centers for Medicare and Medicaid Services’ (CMS) efforts to expand access to home and community-based services (HCBS) in order to reduce dependence on institutional care. These federal efforts include various incentive programs and policies recently offered under the Affordable Care Act. However, data on the strength of each state’s long term services and supports system has not been easily accessible until recently. The report “Raising Expectations: A State Scorecard …

Is There A Trade-Off? Infant Health Outcomes And Managed Care Competition, Shana L. Moore

Theses and Dissertations--Public Policy and Administration

This study offers insights into the impact of competition among Managed Care organizations (MCOs) on infant birthing charges and birth outcomes. Kentucky provides one of the nation’s first case studies to determine successes and failures of Medicaid MCOs, and by doing so, provides a prediction of the impact of Patient Protection Affordable Care Act (PPACA) competition on healthcare costs and birth outcomes. An analysis of a natural policy experiment in the state of Kentucky reveals that infants insured by a Medicaid MCO stay longer in hospitals, are less healthy, and cost more than those insured under Traditional Medicaid prior to …

American Obesity: Rooted In Uncertainty, Institutions And Public Policy, James Woodward

Theses and Dissertations--Public Policy and Administration

Despite the efforts of policymakers, medical professionals, and other stakeholders, obesity and related health problems show no signs of receding from their record-high rates. Public policy has largely taken the form of consumer advice, (e.g., USDA’s Dietary Guidelines). Since consumers bear most of the costs associated with their obesity, the goal of obesity prevention appears to be incentive-compatible, prima facie. That is, there is no a priori case for much further policy intervention unless existing advice is deficient or consumers’ exhibit systematically poor decision-making.

My review of the literature shows that scholars have long conveyed a consistent narrative regarding …

Influence Of Public Insurance On Healthcare Access And Cancer Care, Wafa W. Tarazi

Theses and Dissertations

Medicaid expansion under the Affordable Care Act (ACA) facilitates access to care among vulnerable populations, but 21 states have not yet expanded the program. Tennessee’s Medicaid program experienced a dramatic Medicaid contraction when the program disenrolled approximately 170,000 nonelderly adults in 2005. Pre-ACA expansions were associated with better access to and utilization of healthcare services. However, little is known about the effect of these policy changes on improvement in health outcomes for women diagnosed with breast cancer, access to care for cancer survivors, and the effect of generosity and duration of expansion on access to care.

This dissertation has three …

Implementation Of Self-Directed Supports For Individuals With Intellectual And Developmental Disabilities: A Political Economy Analysis, Matthew P. Decarlo

Theses and Dissertations

Self-directed supports, as a method of service delivery, have grown from small pilot programs in a handful of states to at least one program in every state. For individuals with intellectual and developmental disabilities (IDD), self-direction presents unique opportunities to engage in self-determined behavior and shape the services upon which they rely. Although the evidence base for self-direction is relatively robust, there is a significant lack of information on how implementation of self-direction is faring on the national level. The purpose of this study is to understand how the political and economic factors within and across states have impacted the …

Does Evidence Influence Policy? Resource Allocation And The Indigenous Burden Of Disease Study, Christopher Doran, Rod Ling, Andrew M. Searles, Peter S. Hill

Research outputs 2014 to 2021

Objective

The Indigenous Burden of Disease (IBoD) report is the most comprehensive assessment of Indigenous disease burden in Australia. The aim of the present study was to investigate the potential effect of the IBoD report on Australian Indigenous health policy, service expenditure and research funding. Findings have significance for understanding factors that may influence Indigenous health policy.

Methods

The potential effect of the IBoD report was considered by: (1) conducting a text search of pertinent documents published by the federal government, Council of Australian Governments and the National Health and Medical Research Council of Australia (NHMRC) and observing the quantity …

Political, Economic, And Health Determinants Of Tuberculosis Incidence, Ashley Rutherford

Electronic Theses and Dissertations

The epidemiologic transition has shifted major causes of mortality from infectious disease to chronic disease; however, infectious diseases are again re-emerging as a major global concern (Diamond, 1997; Karlen, 1995; McNeil, 1976). This research aimed to identify potential areas of infectious disease influence that are not health-related in order to help governments and policymakers establish new policies, correct current policies, or further address these issues in order to effectively prevent and combat infectious disease. This study employed a retrospective, cross-sectional, non-experimental design via structural equation modeling (SEM) and examined tuberculosis incidence rates at the country-level. Secondary data from open-source, international …

Neoliberalism Redux: The Global Health Policy Agenda And The Politics Of Cooptation In Latin America And Beyond, Anne E Birn, Laura Nervi, Carlos Eduardo Siqueira

Gastón Institute Publications

This article explores the neoliberal cooptation of social justice-oriented global health policies over the last three decades, from primary health care and ‘health for all’ to various contemporary so-called ‘health equity’ initiatives, such as Universal Health Coverage and ‘health convergence’. The authors illustrate and contextualize the different periods and approaches with examples from a range of Latin American countries, drawing on diverse political experiences and social struggles in the health arena. The analysis concludes with reflections about the region’s experiences of resisting and challenging the neoliberal health agenda, in spite of domestic and global environments that have constrained these efforts, …

A Cross-Sectional Study On Patients' Access To Healthcare In A Developing Nation, Pawan Bhandari

All Graduate Theses, Dissertations, and Other Capstone Projects

The objective of this research study was to gauge the current status of patients' access to health care services in a developing nation or least-developed country (as defined by the World Bank and United Nations), Nepal. Many patients are not privileged to have a hospital at a close proximity in Nepal. They are also forced to travel and wait for long hours due to their inability to pay for services offered by private healthcare institutions. A survey questionnaire was developed to get a snapshot of how long patients travel to get to a public hospital for an outpatient service. The …

Depression Intervention Programs In Low-Income High Schools, Gopika Hari

UROP Posters

It is estimated that 2.6 million adolescents suffer from major depressive episodes each year. Research has noted that symptoms in youth have become indicators of mental health complications later in life. Studies reveal that low income is a risk factor for depression and that socioeconomically-disadvantaged teenagers are more than twice as likely to develop mental illnesses. Only roughly 25% of children with mental illnesses receive adequate help and 80% of these resources come from schools. This study focuses on establishing the importance of depression intervention programs in low-income high schools and on designing novel guidelines for effective protocols. A compilation …

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

Journal of Sustainable Social Impact

Food policy has a unique role for public, nonprofit, private, and academic stakeholders. Growing food in the city is a challenge worldwide. Food systems can be destroyed by external (weather extremes) and internal (zoning regulations) forces. This study explores urban farms as a secondary food source and their common themes across four sectors. A Northeastern U.S. city was the case study to examine how it implemented its formal urban agriculture program. The positive social change implications of urban farms include greater food visibility and food access in low-income areas and more consumer awareness about growing fresh food. This study contributes …

The Word Outside And The Pictures In Our Heads: Contingent Framing Effects Of Labels On Health Policy Preferences By Political Ideology, Sungjong Roh, Jeff Niederdeppe

Research Collection Lee Kong Chian School Of Business

This study uses data from systematic Web image search results and two randomized survey experiments to analyze how frames commonly used in public debates about health issues, oper- ationalized here as alternative word choices, influence public support for health policy reforms. In Study 1, analyses of Bing (N = 1,719), Google (N = 1,872), and Yahoo Images (N = 1,657) search results suggest that the images returned from the search query “sugar-sweetened beverage” are more likely to evoke health-related concepts than images returned from a search query about “soda.” In contrast, “soda” search queries were more likely to incorporate brand-related …

Food Insecurity And Housing Instability In Vulnerable Families, Christian King

Department of Nutrition and Health Sciences: Faculty Publications

Reducing the prevalence of household food insecurity has been a long-standing objective of the federal government. Previous research has found many negative consequences of food insecurity for families and households but has not examined its relationship with housing instability. Using longitudinal data from the Fragile Families and Child Wellbeing Study, difference-in-difference models show that food insecurity is associated with housing instability. The association remains statistically significant after accounting for potential selection and unobserved heterogeneity using propensity score matching and excluding households that experienced prior housing instability from the sample. Examining potential mediating factors, I find that material hardship explains about …

The Disease Burden And The Extent Of Drug Therapy Problems In An Underserved Minority Population Receiving Medication Therapy Management At An Ambulatory Care Free Clinic, D. N. Ombengi, F. A. Ndemo, Ayman M. Noreddin, W. T. Harris

Pharmacy Faculty Articles and Research

Objective: To determine the common medical conditions, medications, and associated drug therapy problems in an underserved minority population receiving medication therapy management services at a large Community Free Clinic compared to the findings of the Minnesota Pharmaceutical Care Project.

Methods: Retrospective cohort study of a random sample of 60 minority patients referred for medication therapy management service at a Community Free Clinic from January 2012 to January 2014. Patient data including demographics, medication experience, past medical and medication history, medical conditions, active medications, allergies, immunization history and drug therapy was systematically evaluated to determine the most common conditions, …

Healthcare Utilization And Expenditure Patterns Among Older Adults With Functional And Medical Decline, Ashley Shields Robertson

Theses and Dissertations

Purpose. As the aged population of this country grows, the U.S. healthcare system will face increased pressure to provide long-term care services and supports to increasing numbers of elderly Medicare beneficiaries. Studies have indicated that unmet long-term care need can lead to increased, unnecessary utilization of the healthcare system, thus further taxing the Medicare system. Little is known about how type of long-term care, as well as how long-term care policies—specifically payment policies—affect health care utilization. The objective of this original dissertation research was to examine the effects of place of residence (community versus residential long-term care facility) and …

No More Mind Games: Content Analysis Of In-Game Commentary Of The National Football League’S Concussion Problem, Jeffrey Parker

Theses and Dissertations (Comprehensive)

American (gridiron) football played at the professional level in the National Football League (NFL) is an inherently physical spectator sport, in which players frequently engage in significant contact to the head and upper body. Until recently, the long-term health consequences associated with on the field head trauma were not fully disclosed to players or the public, potentially misrepresenting the dangers involved in gameplay. Crucial to the dissemination of this information to the public are in-game televised commentators of NFL games, regarded as the primary conduits for mediating in-game narratives to the viewing audience. Using a social constructionist theoretical lens, this …

Experiences Of Victimization And Health Care Access Among Non-Metropolitan Lgbtq+ Individuals, Ashley-Ann Marcotte

Theses and Dissertations (Comprehensive)

Lesbian, gay, bisexual, trans, and queer (LGBTQ+) individuals report substantial rates of violence, discrimination, and negative life events due to homophobia and transphobia and these experiences impact access to health care services and programs (Bauer et al, 2009; Grant, Mottet, Tanis, Harrison, & Keisling, 2010) These experiences result in LGBTQ+ communities needing services, programs, and social supports to provide safer spaces. Although it is well recognized that health care services are not a major determinant of health outcomes and yet use more than 60% of health spending (Canadian Institute for Health Information, 2014; Muzyka, Hodgson, & Prada, 2012). As such, …

Policies And Clinical Practices Regarding Candidacy And Auditory Treatment For Hispanic Pediatric Patients In Cochlear Implant Centers In The United States, Matthew Ehrenburg

Senior Independent Study Theses

This research sought to investigate the policies and clinical practices regarding candidacy and auditory treatment for Hispanic pediatric cochlear implant patients at cochlear implant centers in the United States. More specifically, the study investigated treatment services provided to pediatric patients who are raised in monolingual Spanish, English as a second language (ESL), and bilingual English-Spanish speaking homes. The study made use of survey research to examine cochlear implant centers regarding their policies, clinical practices, and their referral processes for this specific group of cochlear implant recipients. The survey was distributed electronically through the online survey software Qualtrics via email to …

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 …