Health Policy Commons^™

Clash Of The Titans: Medicaid Meets Private Health Insurance, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Throughout its first forty-eight years of life, the federal Medicaid statute lacked a viable insurance pathway for most low-income adults' ineligible for employer-sponsored coverage. In what is arguably the most important public health achievement since the enactment of Medicare and Medicaid fifty years ago, the Patient Protection and Affordable Care Act (ACA) fundamentally alters this picture. Building on earlier breakthroughs for children, the ACA restructures Medicaid to cover poor adults and juxtaposes its new architecture against an affordable and accessible private insurance market for people ineligible for employer-sponsored or government insurance.

Rising Food Insecurity And Conservative Policy In The Us: Impact On The Elderly, Peter S. Arno, Kenneth Knapp, Stephan Russo, Deborah Viola

NYMC Faculty Publications

Food insecurity, a critical problem in the developing world, has recently received increased attention among wealthy nations. Food insecurity, broadly defined, is when a lack of resources prevents household members from having enough food. In the US, food insecurity has been rising while social safety net programs to ameliorate hunger among at-risk households have been targeted for cuts by conservatives. Our main objective was to assess the prevalence and impact of food insecurity among the elderly. In a survey of 500 older, homebound meal clients in New York City, we found that nearly one in five (17%) is food insecure, …

Impact Of Health Insurance Expansions On Nonelderly Adults With Hypertension., Suhui Li, Brian K. Bruen, Paula M. Lantz, David Mendez

Health Policy and Management Faculty Publications

Introduction

Hypertension is a risk factor for cardiovascular disease (CVD), the leading cause of death in the United States. The treatment and control of hypertension is inadequate, especially among patients without health insurance coverage. The Affordable Care Act offered an opportunity to improve hypertension management by increasing the number of people covered by insurance. This study predicts the long-term effects of improved hypertension treatment rates due to insurance expansions on the prevalence and mortality rates of CVD of nonelderly Americans with hypertension.

Methods

We developed a state-transition model to simulate the lifetime health events of the population aged 25 to …

Action For Dental Health Year Two Progress Report, American Dental Association

Action for Dental Health

No abstract provided.

The Core Competencies For Mental, Neurological, And Substance Use Disorder Care In Sub-Saharan Africa, Pamela Y. Collins, Seggane Musisi, Seble Frehywot, Vikram Patel

Health Policy and Management Faculty Publications

The 2010 Global Burden of Disease Study points to a changing landscape in which non-communicable diseases, such as mental, neurological, and substance use (MNS) disorders, account for an increasing proportion of premature mortality and disability globally. Despite evidence of the need for care, a remarkable deficit of providers for MNS disorder service delivery persists in sub-Saharan Africa. This critical workforce can be developed from a range of non-specialist and specialist health workers who have access to evidence-based interventions, whose roles, and the associated tasks, are articulated and clearly delineated, and who are equipped to master and maintain the competencies associated …

Should We Put Our Feet In The Water? Use Of A Survey To Assess Recreational Exposures To Contaminants In The Anacostia River., Rianna Murray, Sacoby Wilson, Laura Dalemarre, Victoria Chanse, Janet Phoenix, Lori Baranoff

Health Policy and Management Faculty Publications

The Anacostia River, a tributary of the Potomac River that flows into the Chesapeake Bay, is highly contaminated with raw sewage, heavy metals, oil and grease, trash, pathogens, excessive sediments, and organic chemicals. Despite this contamination, recreation on the river is very popular, including kayaking, canoeing, rowing, and sport fishing. There is currently no information available on the potential health risks faced by recreational users from exposure to the river’s pollutants. A total of 197 recreational users of the Anacostia River were surveyed regarding general demographic information and their recreational behavior over the previous year, including frequency and duration of …

Health Care Access Dimensions And Cervical Cancer Screening In South Africa: Analysis Of The World Health Survey., Tomi F. Akinyemiju, Jasmine A. Mcdonald, Paula M. Lantz

Health Policy and Management Faculty Publications

Background

Cervical cancer is the most commonly diagnosed cancer and the leading cause of cancer mortality among women in sub-Saharan Africa. Recent recommendations for cervical cancer primary prevention highlight HPV vaccination, and secondary prevention through screening. However, few studies have examined the different dimensions of health care access, and how these may influence screening behavior, especially in the context of clinical preventive services.

Methods

Using the 2003 South Africa World Health Survey, we determined the prevalence of cervical cancer screening with pelvic examinations and/or pap smears among women ages 18 years and older. We also examined the association between multiple …

Transforming Health Professions' Education Through In-Country Collaboration: Examining The Consortia Among African Medical Schools Catalyzed By The Medical Education Partnership Initiative., Zohray M. Talib, Elsie Kiguli-Malwadde, Hannah Wohltjen, Miliard Derbew, Yakub Mulla, David Olaleye, Nelson Sewankambo

Health Policy and Management Faculty Publications

BACKGROUND: African medical schools have historically turned to northern partners for technical assistance and resources to strengthen their education and research programmes. In 2010, this paradigm shifted when the United States Government brought forward unprecedented resources to support African medical schools. The grant, entitled the Medical Education Partnership Initiative (MEPI) triggered a number of south-south collaborations between medical schools in Africa. This paper examines the goals of these partnerships and their impact on medical education and health workforce planning.

METHODS: Semi-structured interviews were conducted with the Principal Investigators of the first four MEPI programmes that formed an in-country consortium. These …

Adapting Pharmaceutical Reimbursement Policies To Manage Spending On High-Priced Drugs, Elizabeth Docteur, Ruth Lopert

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

High Times: Is The Federal Legalization Of Marijuana Next? What The Food And Drug Administration Could Learn From Its Existing Regulations, Christopher B. Erly

American University Journal of Gender, Social Policy & the Law

This student comment examines the efficacy of marijuana being regulated by the Food and Drug Administration. The author discusses and applies potential FDA regulatory models that could be used to regulate marijuana. The comment concludes marijuana could be easily regulated under the current Food and Drug Administration regulatory scheme and suggests that marijuana should be regulated in a manner akin to tobacco rather than as a drug.

Diagnosing An International Health Crisis: A Structural Exploration Of Ebola 2014, Maddison Zayn Jansen

Honors Program Theses

The Ebola crisis of 2014, though concentrated most heavily in three small countries in western Africa, awoke the international community to its lack of effective health crisis infrastructure. As the disease rocked the globe, multinational groups scrambled to help those directly affected and protect the overwhelming majority of people not directly affected. Most preventative measures failed, and pre-existing initiatives to stem the flow of the disease only served to open the floodgates more. After careful examination of the literature surrounding medical, cultural, financial, national, and global circumstances enabling Ebola to flourish, as well as applying individual analysis and examination, it …

Barriers To Health Care Among Laotian Americans In Middle Tennessee, Xaiyavong Saenphansiri

DNP Projects

Background. Laotian Americans have unique heath beliefs and practices. The cultural differences between Laotian American patients and American health care providers can create challenges in achieving not only evidence-based, but also culturally sensitive care. Although the current literature addresses barriers to health care for Asian Americans, there are few studies related to the Laotian-American minority.

Aim. Describing the particular barriers to preventive and curative care in the Laotian-American population in Middle Tennessee would inform strategies for successful prevention and early treatment programs for this population. The purpose of the study is to describe the health beliefs and barriers to …

Nevada Should Opt-In To Organ Policy Changes, Alex Velto

Brookings Mountain West Publications

Organ donation shortages are a problem in Nevada. A shift in policy towards an opt-out system could more than double the number of registered organ donors in Nevada. A Libertarian Paternalistic strategy would allow potential donors to express their preference for organ donations more accurately. Currently Nevada abides by an opt-in policy where people are only organ donors if they explicitly request to become donors. Under an opt-out policy, people would be presumed organ donors unless they requested not to be donors. Policy changes during the 2015 Legislative session were a good start but failed to fully utilize behavioral economics …

A Better Death In Britain?, Barbara A. Noah

Faculty Scholarship

In the United States, patients and physicians often avoid discussing the inevitability of death and planning for it. As a result, opportunities are missed to make choices that comport with patients’ values and preferences. In the absence of such decisions, the default model is to “err on the side of life,” which often results in overtreatment or inappropriate prolongation of life and avoidable suffering. This Article discusses the United States' end-of-life training and care and Britain’s Liverpool Care Pathway as related to end-of-life care availability, quality, and cost. It further sets forth the argument that while the United States' medical …

Kenya Adolescent Sexual And Reproductive Health Policy, Ministry Of Health Kenya

Reproductive Health

This document is a review and revision of the National Adolescent Sexual and Reproductive Health Policy of Kenya, which involved in-depth consultations with a wide range of stakeholders through literature review, interviews, consultative meetings, and reviews of the various drafts. Many changes took place at the national and international levels that needed to be taken into account as the policy was reviewed, including the Constitution of Kenya (2010) with its attendant devolved governance structure as well as demographics, and social, economic, and technological environment. The government has made concerted efforts as part of Vision 2030 to respond to adolescents and …

Expanding Access To Education For Teenage Mothers In Homa Bay County: What ‘Might’ Work, Chi-Chi Undie

Reproductive Health

No abstract provided.

Health Care Use, Out-Of-Pocket Expenditure, And Macroeconomic Conditions During The Great Recession, Juan Du, Takeshi Yagihashi

Economics Faculty Publications

We study how macroeconomic conditions during the Great Recession affected health care utilization and out-of-pocket expenditures of American households. We use two data sources: the Consumer Expenditure (CE) Survey and the Survey of Income and Program Participation (SIPP); each has its own advantages. The CE contains quarterly frequency variables, and the SIPP provides panel data at the individual level. Consistent evidence across the two datasets shows that utilization of routine medical care was counter-cyclical, whereas hospital care was pro-cyclical during the Great Recession. When we examine the pre-recession period, the relationship between macroeconomic conditions and health care use was either …

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 …

What's In A Name? Effects Of The "Mentally Ill" Label On Autonomy, Miriam E. Cruz

CMC Senior Theses

Over the past years, mental health has attracted increased attention throughout the world, in the form of initiatives, programs, support groups, etc. all with goals to increase awareness and support of mental health. The stark discrepancy between the vision driving this mental health movement and our reality comes from a basic misunderstanding. While there are both legislative and cultural efforts in place to reform our mental health system, the two must work hand in hand in order to affect substantial change. Rather than producing a collaborative effort, our legislators and society tend to ignore each other, resulting in isolated attempts …