Health Policy Commons^™

The Healing Power Of Antitrust, Theodosia Stavroulaki

Northwestern University Law Review

Millions of Americans live in hospital deserts—communities where people lack geographic access to hospitals and primary care physicians. People living in these deserts often miss doctor appointments, delay necessary care, and stop adhering to their treatment. In this way, hospital deserts exacerbate the health disparities plaguing America. This Article demonstrates that hospital deserts are not inevitable but the result of several business strategies—including noncompete agreements and merging with competitors—and antitrust enforcers’ unwillingness to recognize these harmful practices as antitrust violations. To cure the issue of hospital deserts, this Article makes three proposals. First, antitrust enforcers and the courts should expand …

Lessons For Public Policy From The Covid-19 Pandemic, Olga Shvetsova

Political Science Faculty Scholarship

In the early 2020s, as the COVID-19 pandemic unfolded, governments, bureaucracies, and health practitioners around the globe faced unforeseen tasks and responsibilities. The novelty and intensity of the crisis spurred innovation and experimentation in public policy, health policy, and crisis management. However, the pandemic also revealed bottlenecks and adverse incentives within policy framework and healthcare systems. From this experience, critical lessons emerged: the paramount importance of swift and well-informed policy responses and the ability to optimize ongoing policy response as the crisis unfolds.

A Caution Against Customized Ai In Healthcare, Kristin M Kostick-Quenet

Center for Medical Ethics and Health Policy Staff Publications

This article critiques the shift towards personalized AI in healthcare and other high-stakes domains, cautioning that without careful deliberation, customized AI systems can compromise the diversity and reach of human knowledge by restricting exposure to critical information that may conflict with users' preferences and biases. Customized AI should be applied with caution and intention where access to a wide and diverse range of perspectives is essential for impartial, informed decision making.

Us Military Veterans’ Perceived Concordance With Their Providers Regarding Persistent Physical Symptoms Prospectively Predicts Satisfaction With Care And Adherence To Care Plans, L Alison Phillips, Laura M Lesnewich, Katharine Bloeser, Yong Lin, Rachel L Boska, Justeen K Hyde, Peter J Bayley, Helena K Chandler, Matthew J Reinhard, Susan L Santos, Rachel Stewart, Drew A Helmer, Lisa M Mcandrew

Center for Medical Ethics and Health Policy Staff Publications

Background: Medically unexplained, persistent physical symptoms and syndromes are commonly seen in primary care. These are debilitating for patients and difficult to treat, causing frustration for patients and providers.

Purpose: This study investigates how well US military veterans with multiple persistent physical symptoms (PPS), called Gulf War illness (GWI), agree with their healthcare providers about their illness. This agreement, called perceived concordance, is hypothesized to influence veterans' satisfaction with care, adherence to care plans, and disability levels.

Methods: Participants were 230 veterans with GWI deployed to the 1990-1991 Gulf War who were recruited from Veteran Affairs primary care and War …

Predictors Of Mental Health Clinic Staff Self-Efficacy In Recognizing And Responding To Suicide Risk, Hannah Ritz

Theses and Dissertations

Staff self-efficacy is critical to suicide prevention, yet its predictors within Zero Suicide initiatives are not well understood. Among 1,038 CCBHC staff, perceived organizational support, response-focused training, and lower suicide myth endorsement most strongly predicted self-efficacy. Clinical role and prior experiences contributed modestly, highlighting multilevel influences on workforce readiness.

An Evaluation Of Nhmrc Funded Dementia And Diabetes Research, Etienne Vignola-Gagné Phd, Dmitrii Malkov, Elisabeth Browning, Jörg Hellwig Phd, Luigi Rocco Phd, Henrique Pinheiro, Alexandre Bédard-Vallée

Public Reports

This report, commissioned by the National Health and Medical Research Council (NHMRC), provides comprehensive insights into the research outputs, outcomes, and impacts of NHMRC-funded health and medical research in the areas of dementia and diabetes to support NHMRC's mission of ‘building a healthy Australia.’

Rural Hospital Closure And Medicaid Expansion, Jason White

Theses, Dissertations and Capstones

Introduction: In the United States, hospitals in rural areas have been under financial pressure and have been closing at an increasing rate.  This reduces access to care for rural citizens.  The Affordable Care Act of 2010 was passed in order to increase access to medical care, partially through an optional expansion of Medicaid coverage to a larger percentage of the population.  As some states adopted the expansion and some states did not, an opportunity was created to examine the policy’s effect on rural hospital stability.

Purpose of the Study:  This study was designed to examine the effect of …

Barriers And Facilitators To Accessing Mental And Physical Health Care Among Sexual Minority Women: A Qualitative Exploration, Charlotte A. Dawson, A. Moulder, Kristin E. Heron

Department Psychiatry & Behavioral Science Faculty Publications

Cisgender sexual minority women (SMW, e.g., lesbian, queer) are at greater risk for poor mental and physical health compared to heterosexual women and face challenges when accessing health care. Previous research has largely focused on general sexual and gender minority barriers to health care, but more research is needed on the experiences of specific subgroups, including cisgender SMW. The current study qualitatively explored barriers and facilitators for cisgender SMW seeking health care. Twenty cisgender SMW aged 18-40 recruited using Meta advertisements and past participant lists completed 45 min semi-structured interviews and a brief survey. Thematic analysis conducted by two coders …

Infant Health Equity In Oklahoma: A Mixed-Methods Exploration Of Personal, Organizational, Environmental, And Policy Factors Contributing To Black Infant Mortality, Ayesha M. Lampkins

West Chester University Doctoral Projects

Black women experience higher rates of adverse birth outcomes, including infant mortality. There is a gap in the literature on multilevel strategies to achieve infant health equity and engage Black women. This study is unique in that no others have looked at the views of Oklahoma Black women to inform and address infant health equity strategies and utilize these views to provide context to existing infant mortality data. The study research questions are: 1) What views on infant health equity and infant mortality are held by Black women in Oklahoma? 2) What differences exist between Black and White mothers in …

Abortion On The Ballot: How Direct Democracy Shapes Abortion Policy Post-Dobbs, Serena E. Klebba

Honors Theses

Since the return of abortion policy to the states following Dobbs v. Jackson Women’s Health Organization (2022), sixteen states have considered ballot measures addressing core questions of abortion access. Distinct from pre-2022 initiatives, these recent measures present binary choices on issues such as viability-based access, six-week bans, and the existence or repudiation of a right to abortion in state constitutions. Although existing scholarship generally frames initiatives and referendums as mechanisms that enhance congruence between public opinion and policy outcomes, this focus overlooks the broader effects of direct democratic processes on voters. I hypothesize that there is something unique in the …

A Learning History Of A State Physical Activity Plan, Jessica Nicole Riffee

Graduate Theses, Dissertations, and Problem Reports (ETD)

Physical inactivity remains a persistent public health concern in the United States, disproportionately affecting rural populations like West Virginia. To address statewide physical activity challenges, West Virginia developed one of the nation’s first state level physical activity plans, ActiveWV: 2015, that was revised to ActiveWV: 2030. Limited research has investigated how statewide physical activity plans unfold over time or how stakeholder learning can drive improvement.

This dissertation employed a learning history action research methodology to construct a collective narrative of the development, dissemination, implementation, and evaluation activities across both iterations of the West Virginia Physical Activity Plan. Reflective interviews with …

Examining Drug Policy In Portugal And Greece, Collin Fernandes

Dissertations and Theses

This thesis examines the divergent drug policies implemented in Portugal and Greece, analyzing why Portugal's comprehensive decriminalization model has been more successful than Greece's partial approach. Since 2001, Portugal has pioneered a drug policy that decriminalizes all drugs for personal use while investing in harm reduction services, rehabilitation, and social reintegration. In contrast, Greece maintained criminalization while implementing more limited harm reduction measures, particularly through OKANA (the Organization Against Drugs). The research highlights how economic factors, particularly the 2008 financial crisis and austerity measures, negatively affected both countries' programs but hit Greece's initiatives with greater severity. Portugal's programs have remained …

Faltered States: The Rise, Fall, And Containment Of Psychedelic Science In The United States, Baxter Brew

CMC Senior Theses

This thesis traces the history of psychedelic science in the United States and its implications for policymaking. In the postwar period, psychedelic researchers were enabled by a unique convergence of optimism in medical science and structural flexibility. But their hope blinded them to the deeper tensions of their field. As institutions grew increasingly rigid and risk-averse, the space for psychedelics began to close. Some scientists responded by fortifying the walls around them, developing socially and professionally acceptable research methods. Others tried to escape these walls entirely. But neither approach could prevent psychedelics from being squeezed out of formal inquiry. Yet …

Moral Panic Or Public Health Crisis? Lessons From Drugs And Gambling For “Addictive” Design, Matthew B. Lawrence, Haomin (Kevin) Yan

Faculty Articles

In her important book, Unwired: Gaining Control Over Addictive Technologies, Gaia Bernstein illustrates the value of a comparative approach, drawing lessons from fights around the regulation of tobacco and ultra-processed food for the regulation of social media. Building on Bernstein’s work, this symposium contribution aims to draw additional insight from experience with drug and gambling regulation for the regulation of social media, video games, AI, and other potentially-addictive technologies.

Specifically, after introducing Bernstein’s book and the foundation it lays, we draw six lessons from the study of psychoactive drugs and gambling. As we elaborate below: Lesson one is that …

Defederalizing Opioid Addiction Care, Matthew B. Lawrence

Faculty Articles

Lack of access to evidence-based care for drug addiction is an urgent problem amid a decades-long overdose crisis that kills tens of thousands of Americans a year. Opioid addiction is the primary driver of overdoses today, and medicines exist to treat such addiction that can dramatically improve quality of life while reducing the risk of deadly overdose by more than half. Yet fewer than one in four of the nine million Americans who need such evidence-based medical care for their addiction receive it. Chief among barriers to access are restrictive and burdensome federal requirements limiting the use of narcotic medications …

Blood Biomarkers In Down Syndrome: Facilitating Alzheimer’S Disease Detection And Monitoring, Melissa E. Petersen, Lisi Flores-Aguilar, Elizabeth Head, Laia Montoliu-Gaya, Andre Strydom, Sarah E. Pape, Juan Fortea, Nicholas J. Ashton, Chinedu Udeh-Momoh, Sid E. O’Bryant, Dwight German, Florin Despa, Mark Mapstone, Henrik Zetterberg

Neurology Faculty Publications

Blood-based biomarkers continue to be explored for disease detection, monitoring of progression, and therapeutic outcomes as the diagnostic determination of Alzheimer’s Disease in Down Syndrome (DS-AD) remains challenging in clinical settings. This perspective highlights the current status of this effort. Overall, amyloid (A), tau (T), and neurodegeneration (AT[N]) blood-based biomarkers have been shown to increase with disease pathology for individuals with DS. Phosphorylated tau biomarkers (p-tau217, p-tau181) have been consistently shown to track disease progression for DS-AD and are likely good candidates for use in clinical settings. Biomarkers of inflammation (glial fibrillary acidic protein) also show promise; however, additional work …

Assisted Living, Residential Care, And Memory Care Staffing Level Dynamics: Oregon, 2017–2023, Sarah Dys, Ozcan Tunalilar

Institute on Aging Publications

Objectives

To examine changes in staffing levels over time in Oregon assisted living and residential care (AL/RC) communities between 2017 and 2023.

Design

Longitudinal study of licensed AL/RC communities.

Setting and Participants

A total of 1720 setting-year observations from 535 individual AL/RC communities in Oregon between 2017 and 2023.

Methods

Primary data were collected through the Oregon Community-Based Care (CBC) study. Staffing levels were estimated as care staff hours per resident per day and reported overall and by staff type, including registered nurses, licensed practical nurses, certified nursing assistants, certified medication aides, unlicensed care staff, life enrichment staff, and social …

Social Determinants Of Health And Aging In Africa: Structural Inequality, Vulnerability, And The Future Of Care, Aremu Umor Lukman, Sunkanmi Folorunsho, Abdulrauf Olaitan Taofeeq

Department of Sociology: Faculty Publications

Population aging is accelerating across Africa yet remains underrepresented in research, policy, and public health planning. This review critically examines how social determinants shape aging experiences across the continent, focusing on health, care systems, and structural inequalities. While traditional African societies have historically valued older adults, modernization, migration, and economic hardship have eroded support systems, leaving many to face old age with limited resources. Older Africans, particularly women and rural residents, contend with lifelong disadvantages including low education, informal labor, poverty, and gendered caregiving roles that contribute to poor health and social vulnerability. Health systems remain poorly equipped to address …

Clinician Perspectives On Virtual Reality Use In Physical Therapy Practice In The United States, Danielle T. Felsberg, Jared T. Mcguirt, Scott E. Ross, Louisa D. Raisbeck, Charlend K. Howard, Christopher K. Rhea

Rehabilitation Sciences Faculty Publications

The primary goal of physical rehabilitation is to assess movement impairments and restore function to improve overall quality of life. Virtual reality (VR) may provide the optimal environment to promote these goals due to its motivating and modifiable nature which can be difficult to accomplish through traditional real-world therapeutic methods. Current research of VR for rehabilitation has demonstrated that VR interventions can produce clinically meaningful change in motor outcomes. Despite this, adoption and usage of VR by physical therapy professionals is unclear due to the limited research in this area. Thus, the purpose of this study was to identify the …

The Influence Of Gender Identity And Healthcare Delivery Experience On Hiv Screening, Delton Harris

Theses and Dissertations

This dissertation examines the roles of gender identity, healthcare experience, and practitioners' scope of healthcare services in the uptake of annual HIV screening among the understudied population of transgender individuals. Transgender individuals are about half as likely to have an annual HIV screening despite having similar risk profiles to men who have sex with men (MSM). The current HIV guidelines for MSM recommend annual HIV screening because of the risky sexual practice, anal sex with other men. Similar to MSM, transgender individuals who have anal sex with men are at higher risk than the general population for HIV acquisition because …