Health Policy

The promise of Mama Kits: Perceptions of in-kind goods as incentives for facility deliveries in Uganda

The promise of Mama Kits: Perceptions of in-kind goods as incentives for facility deliveries in Uganda
Global Public Health, DOI:10.1080/17441692.2016.1149597

Katherine Austin-Evelyn, Emma Sacksa, Lynn Atuyambe, Dana Greeson, Margaret E. Kruk, and Karen A. Grépin
03/07/2016

There is growing interest in the use of incentives to increase the utilisation of maternal health services globally, including the use of in-kind goods. As part of the Saving Mothers, Giving Life (SMGL) programme, pregnant women in three districts in Uganda were incentivised to deliver in a facility by the promise of ‘Mama Kits’ – clean delivery kits augmented with goods for newborns. We collected and analysed qualitative data from 18 focus groups (130 women) who had a recent home (N = 9) or facility delivery (N = 9 groups) to understand their overall perceptions of the SMGL programme, and, in particular, the Mama Kit. There was a high level of awareness of Mama Kits among women who delivered in a health facility and a moderate awareness among women who delivered at home. When available, kits positively affected women's perceptions of facility delivery because they associated availability of kits with affordability of care. When not available, women's perceptions of their actual or expected delivery experience were negatively affected. When well implemented, in-kind goods can be important complements in broader efforts to incentivise facility delivery. Inconsistent implementation and an underestimation of their influence on care-seeking can undermine efforts to reduce maternal mortality and morbidity.

Evaluation Of A Maternal Health Program In Uganda And Zambia Finds Mixed Results On Quality Of Care And Satisfaction

Evaluation Of A Maternal Health Program In Uganda And Zambia Finds Mixed Results On Quality Of Care And Satisfaction
Health Affairs, March 2016 vol. 35 no. 3 510-519, doi:10.1377/hlthaff.2015.0902

Margaret E. Kruk, Daniel Vail, Katherine Austin-Evelyn, Lynn Atuyambe, Dana Greeson, Karen Ann Grépin, Simon P. S. Kibira, Mubiana Macwan’gi, Tsitsi B. Masvawure, Miriam Rabkin, Emma Sacks, Joseph Simbaya and Sandro Galea
03/01/2016

Saving Mothers, Giving Life is a multidonor program designed to reduce maternal mortality in Uganda and Zambia. We used a quasi-random research design to evaluate its effects on provider obstetric knowledge, clinical confidence, and job satisfaction, and on patients’ receipt of services, perceived quality, and satisfaction. Study participants were 1,267 health workers and 2,488 female patients. Providers’ knowledge was significantly higher in Ugandan and Zambian intervention districts than in comparison districts, and in Uganda there were similar positive differences for providers’ clinical confidence and job satisfaction. Patients in Ugandan intervention facilities were more likely to give high ratings for equipment availability, providers’ knowledge and communication skills, and care quality, among other factors, than patients in comparison facilities. There were fewer differences between Zambian intervention and comparison facilities. Country differences likely reflect differing intensity of program implementation and the more favorable geography of intervention districts in Uganda than in Zambia. National investments in the health system and provider training and the identification of intervention components most associated with improved performance will be required for scaling up and sustaining the program.

Variation in Payment Rates under Medicare’s Inpatient Prospective Payment System

Variation in Payment Rates under Medicare’s Inpatient Prospective Payment System
HSR [Health Services Research]. Published online: DOI: 10.1111/1475-6773.12490

Krinsky S, Ryan AM, Mijanovich T, Blustein J
02/04/2016

Objective

To measure variation in payment rates under Medicare's Inpatient Prospective Payment System (IPPS) and identify the main payment adjustments that drive variation.

Data Sources/Study Setting

Medicare cost reports for all Medicare-certified hospitals, 1987–2013, and Dartmouth Atlas geographic files.

Study Design

We measure the Medicare payment rate as a hospital's total acute inpatient Medicare Part A payment, divided by the standard IPPS payment for its geographic area. We assess variation using several measures, both within local markets and nationally. We perform a factor decomposition to identify the share of variation attributable to specific adjustments. We also describe the characteristics of hospitals receiving different payment rates and evaluate changes in the magnitude of the main adjustments over time.

Data Collection/Extraction Methods

Data downloaded from the Centers for Medicare and Medicaid Services, the National Bureau of Economic Research, and the Dartmouth Atlas.

Principal Findings

In 2013, Medicare paid for acute inpatient discharges at a rate 31 percent above the IPPS base. For the top 10 percent of discharges, the mean rate was double the IPPS base. Variations were driven by adjustments for medical education and care to low-income populations. The magnitude of variation has increased over time.

Conclusions

Adjustments are a large and growing share of Medicare hospital payments, and they create significant variation in payment rates.

Telephone Smoking Cessation Counseling for Smokers in Mental Health Clinics: a Patient-Randomized Controlled Trial.

Telephone Smoking Cessation Counseling for Smokers in Mental Health Clinics: a Patient-Randomized Controlled Trial.
American Journal of Preventive Medicine. In press.

Rogers E, Smelson D, Gillespie C, Elbel B, Poole S, Hagedorn H, Kalman D, Krebs P, Fang Y, Wang B, Sherman SE.
01/27/2016

The CBO’s Crystal Ball: How Well Did It Forecast the Effects of the Affordable Care Act?

The CBO’s Crystal Ball: How Well Did It Forecast the Effects of the Affordable Care Act?
S. Glied, A. Arora, and C. Solís-Román, The CBO’s Crystal Ball: How Well Did It Forecast the Effects of the Affordable Care Act? The Commonwealth Fund, December 2015.

Sherry A. Glied, Anupama Arora, Claudia Solis-Roman
12/15/2015

The Congressional Budget Office (CBO), a nonpartisan agency of Congress, made official projections of the Affordable Care Act’s impact on insurance coverage rates and the costs of providing subsidies to consumers purchasing health plans in the insurance marketplaces. This analysis finds that the CBO overestimated marketplace enrollment by 30 percent and marketplace costs by 28 percent, while it underestimated Medicaid enrollment by about 14 percent. Nonetheless, the CBO’s projections were closer to realized experience than were those of many other prominent forecasters. Moreover, had the CBO correctly anticipated income levels and health care prices in 2014, its estimate of marketplace enrollment would have been within 18 percent of actual experience. Given the likelihood of additional reforms to national health policy in future years, it is reassuring that, despite the many unforeseen factors surrounding the law’s rollout and participation in its reforms, the CBO’s forecast was reasonably accurate.

A comparative analysis of hospital readmissions in France and the US

A comparative analysis of hospital readmissions in France and the US

Gusmano, MK, Rodwin, VG, Weisz, D, Cottenet, J, and Quantin, C.
10/04/2015

Policymakers in the US and France are struggling to improve coordination among
hospitals and other health care providers. A comparison of hospital readmission rates, and the factors that may explain them, can provide important insights about the French and US health care systems. In addition, it illustrates a methodological approach to comparative research: how an empirical inquiry along a single indicator can reveal broader issues about system-wide differences across health care systems and policy. Using data from three French regions, the article extends a
previous national-level comparison indicating that rates of hospital readmission for the population aged 65+ are lower in France than in the US. In addition, we extend the range of variables available in the national comparison by drawing on neighborhood-level income data available from a previous study of access to primary care among three French regions. Within France, the odds of surgical hospital readmission are significantly lower in private for-profit hospitals compared with public hospitals. Patients who live in lower income neighborhoods are also more likely to be readmitted for medical and surgical conditions than are patients living in higher income neighborhoods, but this income effect is weaker than in the US. The article concludes with a discussion of how these findings reflect broader system-wide differences between the US and French health systems and the ways in which policymakers attempt to coordinate hospitals and community based services.

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