Health Policy

Potentially avoidable hospitalizations: how to estimate the costs?

Potentially avoidable hospitalizations: how to estimate the costs?
Gestion Hospitalière (529) October, 2013

Rodwin, V., A. Sommer, and D. Weisz
10/01/2013

Based on the number of hospitalizations for ambulatory-care sensitive conditions in the Paris region (Ile-de-France), and the DRG-based rates for these hospital stays, we estimate the hospital expenditures that could be avoided if patients had access to primary care services that successfully manage their chronic conditions and avoid exacerbations that lead to necessary hospitalizations when they occur. In addition, we caution policymakers about what inferences can legitimately be drawn from such estimates for the expenditures averted on hospital care do not represent a net gain as there would likely be additional expenditures needed to upgrade ambulatory care to manage a host of complex chronic diseases.

Democratization and Universal Health Coverage: A comparison of the experiences of Ghana, Kenya, and Senegal

Democratization and Universal Health Coverage: A comparison of the experiences of Ghana, Kenya, and Senegal
Global Health Governance, 6(2): 1-27.

Grépin, Karen and Kim Yi Dionne
09/23/2013

This article identifies conditions under which newly established democracies adopt Universal Health Coverage. Drawing on the literature examining democracy and health, we argue that more democratic regimes – where citizens have positive opinions on democracy and where competitive, free and fair elections put pressure on incumbents – will choose health policies targeting a broader proportion of the population. We compare Ghana to Kenya and Senegal, two other countries which have also undergone democratization, but where there have been important differences in the extent to which these democratic changes have been perceived by regular citizens and have translated into electoral competition. We find that Ghana has adopted the most ambitious health reform strategy by designing and implementing the National Health Insurance Scheme (NHIS). We also find that Ghana experienced greater improvements in skilled attendance at birth, childhood immunizations, and improvements in the proportion of children with diarrhea treated by oral rehydration therapy than the other countries since this policy was adopted. These changes also appear to be associated with important changes in health outcomes: both infant and under-five mortality rates declined rapidly since the introduction of the NHIS in Ghana. These improvements in health and health service delivery have also been observed by citizens with a greater proportion of Ghanaians reporting satisfaction with government handling of health service delivery relative to either Kenya or Senegal. We argue that the democratization process can promote the adoption of particular health policies and that this is an important mechanism through which democracy can improve health.

Helping Without Harming: The Instructor’s Feedback Dilemma in Debriefing—A Case Study

Helping Without Harming: The Instructor’s Feedback Dilemma in Debriefing—A Case Study
Stimulation in Healthcare: The Journal of the Society for Simulation in Healthcare. October 2013 - Volume 8 - Issue 5 - p 304-316. doi: 10.1097/SIH.0b013e318294854e

Rudolph, J. W., Foldy, E. G. et al.
09/18/2013

Introduction

Simulation instructors often feel caught in a task-versus-relationship dilemma. They must offer clear feedback on learners’ task performance without damaging their relationship with those learners, especially in formative simulation settings. Mastering the skills to resolve this dilemma is crucial for simulation faculty development.

Methods

We conducted a case study of a debriefer stuck in this task-versus-relationship dilemma. Data: The “2-column case” captures debriefing dialogue and instructor’s thoughts and feelings or the “subjective experience.” Analysis: The “learning pathways grid” guides a peer group of faculty in a step-by-step, retrospective analysis of the debriefing. The method uses vivid language to highlight the debriefer’s dilemmas and how to surmount them.

Results

The instructor’s initial approach to managing the task-versus-relationship dilemma included (1) assuming that honest critiques will damage learners, (2) using vague descriptions of learner actions paired with guess-what-I-am-thinking questions, and (3) creating a context she worried would leave learners feeling neither safe nor clear how they could improve. This case study analysis identified things the instructor could do to be more effective including (1) making generous inferences about the learners’ qualities, (2) normalizing the challenges posed by the simulation, (3) assuming there are different understandings of what it means to be a team.

Conclusions

There are key assumptions and ways of interacting that help instructors resolve the task-versus-relationship dilemma. The instructor can then provide honest feedback in a rigorous yet empathic way to help sustain good or improve suboptimal performance in the future.

Enforcing food quality and safety standards in Brazil: The case of COBRACANA

Enforcing food quality and safety standards in Brazil: The case of COBRACANA
The Annals of the American Academy of Political and Social Science 2013, 649 (1), pp.122-138

Coslovsky, Salo
09/16/2013

Globalization of production has been complemented by increasingly stricter product quality and safety regulations. This trend is particularly acute in the food and beverage sectors, which puts enormous strain on producers from developing nations. This paper examines the trajectory of a cooperative of sugarcane, sugar and ethanol producers from Brazil that, once confronted with this challenge, failed to meet the standards but ultimately came around. It credits the coop’s turnaround to three variables: (a) a new cost accounting methodology that monetized some of the differences in product quality and attenuated tensions among the membership; (b) a low-cost but high-powered system of regulatory incentives that subverted rigid hierarchies and empowered middle-managers vis-à-vis top-executives; and (c) the action of external auditors who acted not as police-officers or consultants, but as conduits who reestablished information flows and helped create a business atmosphere conducive to productive change.

Medicaid's Next Metamorphosis

Medicaid's Next Metamorphosis
Public Administration Review, Vol 73, no. 4

Charles Brecher and Shanna Rose
08/20/2013

Medicaid’s transformation since its inception rivals the biological changes of metamorphosis, and that process is not yet over. Past metamorphoses are the change from a small program with eligibility linked to the states’ cash welfare benefits to one with national eligibility standards covering many not receiving cash benefits, from a traditional fee-for-service payment program to one dominated by capitated managed care arrangements, and under the ACA to a widely accepted component of a national system for near universal insurance coverage. An analysis of the forces behind these significant changes suggests that future transformations are likely, and four potential scenarios are presented and assessed.

Disparities in access to health care in three French regions

Disparities in access to health care in three French regions
Health Policy, DOI 10.1016/j.healthpol.

Michael K. Gusmano, Daniel Weisz, Victor G. Rodwin, Jonas Lang, Meng Quian, Aurelie Bocquier, Veronique Moysan, Pierre Verger
08/05/2013

Objectives: This paper compares access to primary and specialty care in three metropolitan regions of France: Ile de France (IDF), Nord-Pas-de-Calais (NPC) and Provence-Alpes-Côte d’Azur (PACA); and identifies the factors that contribute to disparities in access to care within and among these regions.

Methods: To assess access to primary care, we compare variation among residence-based, age-adjusted hospital discharge rates for ambulatory care sensitive conditions (ASC). To assess access on one dimension of specialty care, we compare residence-based, age- adjusted hospital discharge rates for revascularization – bypass surgery and angioplasty – among patients diagnosed with ischemic heart disease (IHD). In addition, for each region we rely on a multilevel generalized linear mixed effect model to identify a range of individual and area-level factors that affect the discharge rates for ASC and revascularization. Results: In comparison with other large metropolitan regions, in France, access to primary care is greater in Paris and its surrounding region (IDF) than in NPC but worse than in PACA. With regard to revascularization, after controlling for the burden of IHD, use of services is highest in PACA followed by IDF and NPC. In all three regions, disparities in access are much greater for revascularization than for ASC. Residents of low-income areas and those who are treated in public hospitals have poorer access to primary care and revascularizations. In addition, the odds of hospitalization for ASC and revascularization are higher for men. Finally, people who are treated in public hospitals, have poorer access to primary care and revascularization services than those who are admitted for ASC and revascularization services in private hospitals.

Conclusions: Within each region, we find significant income disparities among geographic areas in access to primary care as well as revascularization. Even within a national health insurance system that minimizes the financial barriers to health care and has one of the highest rates of spending on health care in Europe, the challenge of minimizing these disparities remains.

Partisan Priorities: How Issue Ownership Drives and Distorts American Politics

Partisan Priorities: How Issue Ownership Drives and Distorts American Politics
Cambridge University Press.

Egan, Patrick J.
07/22/2013

Americans consistently name Republicans as the party better at handling issues like national security and crime, while they trust Democrats on issues like education and the environment – a phenomenon called “issue ownership.” Partisan Priorities investigates the origins of issue ownership, showing that in fact the parties deliver neither superior performance nor popular policies on the issues they “own.” Rather, Patrick J. Egan finds that Republicans and Democrats simply prioritize their owned issues with lawmaking and government spending when they are in power. Since the parties tend to be particularly ideologically rigid on the issues they own, politicians actually tend to ignore citizens' preferences when crafting policy on these issues. Thus, issue ownership distorts the relationship between citizens' preferences and public policies.

Overweight, obesity, and inactivity and urban design in rapidly growing Chinese cities

Overweight, obesity, and inactivity and urban design in rapidly growing Chinese cities
Health & Place, 21, 29-38. http://dx.doi.org/10.1016/j.healthplace.2012.12.009

Day, K, M Alfonzo, Y F Chen, Z Guo, and K K Lee
05/01/2013

China faces rising rates of overweight, obesity, and physical inactivity among its citizens. Risk is highest in China’s rapidly growing cities and urban populations. Current urban development practices and policies in China heighten this risk. These include policies that support decentralization in land use planning; practices of neighborhood gating; and policies and practices tied to motor vehicle travel, transit planning, and bicycle and pedestrian infrastructure. In this paper, we review cultural, political, and economic issues that influence overweight, obesity, and inactivity in China. We examine key urban planning features and policies that shape urban environments that may compromise physical activity as part of everyday life, including walking and bicycling. We review the empirical research to identify planning and design strategies that support physical activity in other high-density cities in developing and developed countries. Finally, we identify successful strategies to increase physical activity in another growing, high-density city – New York City – to suggest strategies that may have relevance for rapidly urbanizing Chinese cities.

Race/Ethnicity-Specific Associations of Urinary Phthalates with Childhood Body Mass in a Nationally Representative Sample

Race/Ethnicity-Specific Associations of Urinary Phthalates with Childhood Body Mass in a Nationally Representative Sample
Environmental Health Perspectives. 121:501-506.

Trasande, Leonardo, Teresa M Attina, S Sathyanarayana, Adam J Spanier, Jan Blustein.
04/01/2013

Background: Phthalates have antiandrogenic effects and may disrupt lipid and carbohydrate metabolism. Racial/ethnic subpopulations have been documented to have varying urinary phthalate concentrations and prevalences of childhood obesity.

Objective: We examined associations between urinary phthalate metabolites and body mass outcomes in a nationally representative sample of U.S. children and adolescents.

Methods: We performed stratified and whole-sample cross-sectional analyses of 2,884 children 6–19 years of age who participated in the 2003–2008 National Health and Nutrition Examination Survey. Multivariable linear and logistic analyses of body mass index z-score, overweight, and obesity were performed against molar concentrations of low-molecular-weight (LMW), high-molecular-weight (HMW), and di-2-ethylhexylphthalate (DEHP) metabolites, controlling for sex, television watching, caregiver education, caloric intake, poverty–income ratio, race/ethnicity, serum cotinine, and age group. We used sensitivity analysis to examine robustness of results to removing sample weighting, normalizing phthalate concentrations for molecular weight, and examining different dietary intake covariates.

Results: In stratified, multivariable models, each log unit (roughly 3-fold) increase in LMW metabolites was associated with 21% and 22% increases in odds (95% CI: 1.05–1.39 and 1.07–1.39, respectively) of overweight and obesity, and a 0.090-SD unit increase in BMI z-score (95% CI: 0.003–0.18), among non-Hispanic blacks. Significant associations were not identified in any other racial/ethnic subgroup or in the study sample as a whole after controlling for potential confounders, associations were not significant for HMW or DEHP metabolites, and results did not change substantially with sensitivity analysis.

Conclusions: We identified a race/ethnicity–specific association of phthalates with childhood obesity in a nationally representative sample. Further study is needed to corroborate the association and evaluate genetic/epigenomic predisposition and/or increased phthalate exposure as possible explanations for differences among racial/ethnic subgroups.

Pages

Subscribe to Health Policy