Health Policy Commons^™

Libertarian Patriarchalism: Nudges, Procedural Roadblocks, And Reproductive Choice, Govind Persad

Georgetown Law Faculty Publications and Other Works

Cass Sunstein and Richard Thaler's proposal that social and legal institutions should steer individuals toward some options and away from others-a stance they dub "libertarian paternalism"-has provoked much high-level discussion in both academic and policy settings. Sunstein and Thaler believe that steering, or "nudging," individuals is easier to justify than the bans or mandates that traditional paternalism involves.

This Article considers the connection between libertarian paternalism and the regulation of reproductive choice. I first discuss the use of nudges to discourage women from exercising their right to choose an abortion, or from becoming or remaining pregnant. I then argue that …

Future Oversight Of Recombinant Dna Research: Recommendations Of An Institute Of Medicine Committee, Lawrence O. Gostin, Bruce M. Altevogt, Andrew M. Pope

Georgetown Law Faculty Publications and Other Works

The National Institutes of Health (NIH) established the Recombinant DNA Advisory Committee (RAC) in 1974 in response to public concerns about the safety of manipulating genetic material through recombinant DNA. The accumulation of 40 years of experience with gene transfer research has led to a better understanding of the risks. Yet, as gene transfer research has matured, the complexity of the overall regulatory environment has remained. Gene transfer research continues to be subjected to multiple layers of review: the Food and Drug Administration (FDA), institutional review boards, institutional biosafety committees, and the RAC. It is within the context of overlapping …

Governing For Health As The World Grows Older: Healthy Lifespans In Aging Societies, Lawrence O. Gostin, Anna Garsia

Georgetown Law Faculty Publications and Other Works

So much of global health governance focuses intensely on a brief moment in the human lifespan—from a safe birth to infant and child survival. Yet, with all the attention to this early window of life (infancy to age five), the opposite end of the life spectrum is comparatively neglected. The Millennium Development Goals (MDGs) do not mention a healthy lifespan or a healthy old age. This inadequate attention to the older years of the life appears to be a glaring omission given the universal challenges posed by aging societies. Aging is a demographic fact in almost all countries, but it …

Evaluation Of The Jewish Community Housing For The Elderly Memory Support Initiative, Joan Hyde

Gerontology Institute Publications

Jewish Community Housing for the Elderly (JCHE) is a large, multi-campus organization that houses and serves 1,500 residents (80 market rate and 1,420 low income). The average age is 80 years old, with one-third of residents 85 and older. Three quarters of the residents are not native English speakers. Through HUD and other funding, JCHE offers a range of supports to these residents, including translators, interpreters and staff with language and cultural competence, meals, transportation and, through their Service Coordinators, facilitation of resident access to government benefits, home care and other services.

According to the Alzheimer’s Association’s 2012 special report …

Perceptions Of The Counseling Profession: From Health Science Graduate Faculty And Students, Kaprea F. Johnson, Christianne Fowler, Karen Kott, Margaret Lemaster

Ellmer School of Nursing Faculty Publications

Counseling is considered a newer healthcare profession and possibly unknown to others. This study uses a post-positivist phenomenological approach exploring healthcare faculty and students' perceptions of counseling professionals after participating in a semester long interprofessional health promotions and maintenance course. Results indicated most professions are unaware of counselors, their scope of practice, and their benefit to interprofessional teams. Participants showed growth in their knowledge. Results indicate the importance of interprofessional education and need for advocacy awareness.

Crossing The Border For The Pill: An Analysis Of The Decision To Purchase Oral Contraceptives Over-The-Counter From Mexican Pharmacies, Nadine Johnson

MPA/MPP/MPFM Capstone Projects

In 2012, the American College of Obstetricians and Gynecologists published an opinion statement in which they acknowledged that oral contraceptives were safe to be sold over the counter. Although there are several arguments that the lack of insurance of over the counter birth control would create a bigger cost barrier, research shows that women are in fact willing to pay for contraception if it is available over the counter. Some countries, such as Mexico, have this option available and because of the proximity to the United States, many women who live on the southern border take advantage of this. However, …

The Patient Protection And Affordable Care Act’S Effects On Patterns Of Coverage In A Ryan White Funded Hiv Clinic: What Are The Implications For The Bluegrass Care Clinic?, Jacqueline Wagner Mccuddy

MPA/MPP/MPFM Capstone Projects

The Ryan White CARE Act of 1991 implemented a federal grant program to help individuals in the US with HIV/AIDS get access to healthcare and diminish barriers to care. Since its enactment, there have been many changes in the environment of HIV/AIDS, including a demographic shift in those most affected by the disease and a growing number of new infections, the introduction of Antiretroviral therapy, and most recently, the implementation of the Patient Protection and Affordable Care Act (PPACA).

The PPACA is expected to have a positive effect on patients with HIV in the US by increasing access to care, …

Utilization Of The Kentucky Aids Drug Assistance Program Versus Kentucky Medicaid Using Medication Possession Ratio: Policy Implications For Public Program, Jenna Parrett

MPA/MPP/MPFM Capstone Projects

Uninsured and underinsured people living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) are able to utilize federally funded AIDS Drug Assistance Programs (ADAPs) to cover the price of their HIV-related medications. In Kentucky, this program also provides support services through social workers, a dedicated pharmacist, and medications by mail order. With the Affordable Care Act, many patients previously covered by the Kentucky AIDS Drug Assistance Program (KADAP) will be newly eligible for Medicaid and will no longer receive services through KADAP. There is concern that people in this situation will be at a disadvantage without these services and, in …

Earth, Air, Water, Oil: Regulating Fracking In The Monterey Shale With Health And Environment In Mind, Gideon J. Salzman-Gubbay

Pomona Senior Theses

“Earth, Air, Water, Oil: Regulating Fracking in the Monterey Shale with Health and Environment in Mind,” explores how hydraulic fracturing regulation in California’s oil-rich Monterey Shale will impact regional public health, including groundwater and air quality. This is achieved through a combination of case study and policy analysis on both the state and national level.

An Analysis Of Capacity Issues Within The Division Of Mental And Behavioral Health For The State Of Nevada, Jeffrey Buchwald, Tara Cooley, Enrique Mazon Jr., Jessica Sifuentes

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background

Nevada’s competitiveness in receiving federal funding has been a serious and contentious topic that has steered recent efforts to ascertain ways the state can increase and utilize federal dollars efficiently. Nevada is positioned 53rd out of 53 U.S. states and territories in bringing federal dollars to the state, missing out on $1.5 billion annually (Gustafson, 2012). Nevada spends far less on Medicaid (per capita) than any other state. Medicaid is a key factor in improving Nevada’s position; however, there are additional non-formula funding opportunities that are missed every year.

Purpose

The purpose of this evaluation project is to identify …

Behavioral And Mental Health In Nevada, David Caloiaro, Luana Ritch

Social Health of Nevada Reports

Until recently, the Nevada Division of Mental Health and Developmental Services (MHDS) was the public provider of mental health, substance abuse and developmental services. On July 1, 2013, the delivery of the mental health, substance abuse and developmental services in Nevada was restructured on several levels. With this reorganization, Developmental Services for persons with intellectual disabilities was transitioned into the Aging and Disability Services Division (ADSD), while mental health and substance abuse services were integrated to become Behavioral Health. Behavioral Health was then merged with the public health from the State Health Division to form the new Division of Public …

Public Health Emergencies: What Counts?, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Vaccines and drugs to prevent and treat Ebola Virus Disease that have never been tested in humans, and in scarce supply raise profound ethical challenges. What if good evidence emerged demonstrating safety and efficacy of drugs? What would be an ethical method of allocating scarce beneficial resources? The apparent preference given to foreign aid workers over West Africans provoked a firestorm. In addition to discussing the ethical allocation of scarce drugs, this article also asks a more fundamental question: Why did it take nearly 40 years after the first Ebola outbreak in 1976 to launch clinical trials?

Nets Or Vaccines: Malaria Vaccine Research, David Ernenwein

Pepperdine Policy Review

The global battle against malaria has seen many victories in the developed world but the undeveloped world and particularly Africa continue to suffer from this disease. The development of the RTS,S vaccine and ongoing research into additional vaccines have been touted as the solution to the crisis. However, the news of the successful RTS,S trial should be viewed with caution. Concerns over the effectiveness of the existing vaccine and the cost of further development may not be justified, especially given the known effectiveness of current treatment methods. This research must be watched carefully lest the allure of the vaccine blind …

Mass Shootings And Mental Health Policy, Jessica Rosenberg

The Journal of Sociology & Social Welfare

Research suggests that mass shootings can increase mental health stigma, reinforce stereotypes that people with mental illness are violent, and influence public policy. This article examines mental health policy initiatives resulting from the mass shootings in Sandy Hook, Connecticut and Aurora, Colorado within the context of existing research about mental illness, suicide, substance abuse and gun violence. Previous legislation that restricts access to firearms among persons with mental illness is reviewed. The article suggests that gun control legislation that focuses on persons with mental illness is not supported by research, may create barriers to treatment, and may have limited efficacy …

Right-Skilling: Rabbis And The Rabbinic Role For A New Century, Barak D. Richman, Daniel Libenson

Faculty Scholarship

This chapter applies Clayton Christensen's model of organizational innovation to Jewish contexts. It observes a parallel between the many challenges that currently confront U.S. healthcare and American Jewry: a mismatch in the skills acquired by professionals and the needs expressed by the broader public; expensive institutions with high fixed costs that are struggling to provide value and maintain sustainable revenues; a failure to respect individual autonomy and cultural mores; and a disenfranchised public that suffers from high costs and unmet demand for meaningful services. It then applies Christensen's adapted model for the healthcare sector to American Jewish institutions, suggesting reforms …

Navigating The Health Care Labyrinth: Portraits Of The Socioeconomically Disadvantaged, Thomas C. Crawford Phd

Antioch University Dissertations & Theses

In 2010, an estimated population of the 311,212,863 Americans generated approximately 1,014,688,290 physician office encounters (Moore, 2010). The frequency and number of professional interactions between caregivers and patients/family members in medical office settings equated to a staggering 1,931 visits per minute. Based on the massive volume of interactions that occurred between patients of different races, ethnicities, genders, sexual orientations, and socioeconomic standings that generated an average household income of $49,445 in 2010 (United States Census Bureau, 2010a) with a physician workforce that the Association of American Medical Colleges (2010) captured as being 75% White that earned (primary care specialties) in …

Dementia In Maine: Characteristics, Care, And Cost Across Settings [Chartbook], Julie T. Fralich Mba, Stuart Bratesman Mpp, Louise Olsen, Catherine Mcguire Bs, Tina Gressani, Karen Mauney, Catherine Gunn, Romaine Turyn

Disability & Aging

This report provides a baseline picture of the current use of services by people with and without dementia in Maine.

Measurement, Monitoring, And Evaluation Of State Demonstrations To Integrate Care For Dual Eligible Individuals: Massachusetts Evaluation Design Plan., Julie T. Fralich Mba, Maureen Booth Mrp, Ma, Edith G. Walsh Phd, Angela M. Greene Ms, Mba, Melissa Morley Phd, Wayne Anderson Phd

Disability & Aging

CMS contracted with RTI International to monitor the implementation of all State demonstrations under the Financial Alignment Initiative, and to evaluate their impact on beneficiary experience, quality, utilization, and cost. The evaluation includes an aggregate evaluation and State-specific evaluations. This report describes the State-specific Evaluation Plan for the Massachusetts demonstration as of December 16, 2013. The evaluation activities may be revised if modifications are made to either the Massachusetts demonstration or to the activities described in the Aggregate Evaluation Plan (Walsh et al., 2013). Although this document will not be revised to address all changes that may occur, the annual …

Evaluating Quality Improvement To Improve Hiv Reporting, Nandi A. Marshall, William C. Livingood, Angela Peden, Gulzar H. Shah, Russ Toal, Dayna Alexander, Alesha Wright, Sandra Jump, Shelby Freeman, Kay Davis, Lynn Woodhouse, Kellie Penix

Frontiers in Public Health Services and Systems Research

The incorporation and evaluation of Quality Improvement into Georgia’s public health systems continues to be a focus of the Georgia Public Health Practice Based Research Network. This report describes the process, preliminary results and lessons learned from incorporating Quality Improvement into one of Georgia’s public health districts.

Evidence Use In New York City Public Health Policymaking, Miriam J. Laugesen, Kimberley R. Isett

Frontiers in Public Health Services and Systems Research

New York City Mayor Michael R. Bloomberg has attracted national attention for his public health policy reforms. The policy process behind the reform program has received less scrutiny, especially the use of research by policymakers. We show that the process used to develop, promote, and evaluate polices is heavily based on five types of data and research. New York Department of Health and Mental Hygiene staff conducted in-depth appraisals of existing published research, used local health surveys and private laboratory surveillance data, engaged in “shoe-leather” field research, formed research collaborations within and outside government, and disseminated research to legitimize policy …