Health Policy

Some Reflections On A Few Of The Pitfalls In The World Of Foundation Grant Making

Some Reflections On A Few Of The Pitfalls In The World Of Foundation Grant Making
Health Affairs, Nov/Dec 2007, Vol. 26 Issue 6, p1772-1775, 4p.

Billings, J.
11/01/2007

This paper offers some reflections on the grant-making process from a former foundation executive. Some of the opportunities, challenges, and pitfalls inherent in the foundation world are described, and one approach to grant making, the "call for proposals," is examined as an example of the need for greater attention to and investment in the science of grant making itself, to maximize the potential return from philanthropy.

The President's Proposed Standard Deduction for Health Insurance: Evaluation and Recommendations

The President's Proposed Standard Deduction for Health Insurance: Evaluation and Recommendations
National Tax Journal, Sep 2007, Vol. 60 Issue 3, p433-454, 22p.

Burman, L.E., Furman, J., Leiserson, G. & Williams Jr, R.C.
09/01/2007

The President's proposal to replace the current exclusion of employer-paid health insurance premiums with a standard deduction for qualifying health insurance would level the playing field for employment-based coverage and private plans but would risk the loss of insurance for many workers, threaten existing risk- sharing pools, and unfairly favor the wealthy. This paper evaluates the President's plan, suggests changes that would improve it, and assesses alternatives that would address the plan's shortcomings and improve its likelihood of expanding coverage to many families who now lack insurance.

Notes from the Field: Jumpstarting the IRB Approval Process in Multicenter Studies

Notes from the Field: Jumpstarting the IRB Approval Process in Multicenter Studies
Health Services Research, Volume 42, Number 4, August 2007 , pp. 1773-1782(10) Blackwell Publishing.

Blustein, J., Regenstein, M., Seigel, B. & Billings, J.
08/01/2007

Objective. To identify strategies that facilitate readiness for local Institutional Review Board (IRB) review, in multicenter studies.

Study Setting. Eleven acute care hospitals, as they applied to participate in a foundation-sponsored quality improvement collaborative.

Study Design. Case series.

Data Collection/Extraction. Participant observation, supplemented with review of written and oral communications.

Principal Findings. Applicant hospitals responded positively to efforts to engage them in early planning for the IRB review process. Strategies that were particularly effective were the provisions of application templates, a modular approach to study description, and reliance on conference calls to collectively engage prospective investigators, local IRB members, and the evaluation/national program office teams. Together, these strategies allowed early identification of problems, clarification of intent, and relatively timely completion of the local IRB review process, once hospitals were selected to participate in the learning collaborative.

Conclusions. Engaging potential collaborators in planning for IRB review may help expedite and facilitate review, without compromising the fairness of the grant-making process or the integrity of human subjects protection.

The Effects of Acculturation on Asthma Burden in a Community Sample of Mexican American Schoolchildren

The Effects of Acculturation on Asthma Burden in a Community Sample of Mexican American Schoolchildren
American Journal of Public Health, Jul 2007, Vol. 97 Issue 7, p1290-1296, 7p.

Martin, M.A., Shalowitz, M.U., Mijanovich, T., Clark-Kauffman, E., Perez, E. & Berry, C.
07/01/2007

We sought to determine whether low acculturation among Mexican American caregivers protects their children against asthma. Methods. Data were obtained from an observational study of urban pediatric asthma. Dependent variables were children's diagnosed asthma and total (diagnosed plus possible) asthma. Regression models were controlled for caregivers' level of acculturation, education, marital status, depression, life stress, and social support and children's insurance. Results. Caregivers' level of acculturation was associated with children's diagnosed asthma (P=.025) and total asthma (P=.078) in bivariate analyses. In multivariate models, protective effects of caregivers' level of acculturation were mediated by the other covariates. Independent predictors of increased diagnosed asthma included caregivers' life stress (odds ratio [OR]= 1.12, P=.005) and children's insurance, both public (OR=4.71, P=.009) and private (OR = 2.87, P=.071). Only caregiver's life stress predicted increased total asthma (OR = 1.21, P=.001). Conclusions. The protective effect of caregivers' level of acculturation on diagnosed and total asthma for Mexican American children was mediated by social factors, especially caregivers' life stress. Among acculturation measures, foreign birth was more predictive of disease status than was language use or years in country. Increased acculturation among immigrant groups does not appear to lead to greater asthma risk.

Financial Management for Nurse Managers and Executives

Financial Management for Nurse Managers and Executives
3rd Edition, W.B. Saunders/Elsevier, Spring

Finkler, S.A., Kovner, C.T. & Jones, C.
04/01/2007

Covering the financial topics all nurse managers need to know and use, this book explains how financial management fits into the healthcare organization. You'll study accounting principles, cost analysis, planning and control management of the organization's financial resources, and the use of management tools. In addition to current issues, this edition also addresses future directions in financial management.

Reductions In Firearm-Related Mortality And Hospitalizations In Brazil After Gun Control

Reductions In Firearm-Related Mortality And Hospitalizations In Brazil After Gun Control
Health Affairs, Mar/Apr 2007, Vol. 26 Issue 2, p575-584, 10p.

de Souza, M., de Fatima, M., Macinko, J., Alencar, A.P., Malta, D.C. & de Morais Neto, O.L.
03/01/2007

This paper provides evidence suggesting that gun control measures have been effective in reducing the toll of violence on population health in Brazil. In 2004, for the first time in more than a decade, firearm-related mortality declined 8 percent from the previous year. Firearm-related hospitalizations also reversed a historical trend that year by decreasing 4.6 percent from 2003 levels. These changes corresponded with anti-gun legislation passed in late 2003 and disarmament campaigns undertaken throughout the country since mid-2004. The estimated impact of these measures, if they prove causal, could be as much as 5,563 firearm-related deaths averted in 2004 alone.

Closing the Access Gap for Health Innovations: an Open Licensing Proposal for Universities

Closing the Access Gap for Health Innovations: an Open Licensing Proposal for Universities
Globalization and Health 2007, Vol. 3, no. 1. DOI:10.1186/1744-8603-3-1

Chaifetz, S., D. Chokshi, R. Rajkumar, D. Scales, and Y. Benkler
02/01/2007

Background: This article centers around a proposal outlining how research universities could leverage their intellectual property to help close the access gap for health innovations in poor countries. A recent deal between Emory University, Gilead Sciences, and Royalty Pharma is used as an example to illustrate how 'equitable access licensing' could be put into practice.

Discussion: While the crisis of access to medicines in poor countries has multiple determinants, intellectual property protection leading to high prices is well-established as one critical element of the access gap. Given the current international political climate, systemic, government-driven reform of intellectual property protection seems unlikely in the near term. Therefore, we propose that public sector institutions, universities chief among them, adopt a modest intervention – an Equitable Access License (EAL) – that works within existing trade-law and drug-development paradigms in order to proactively circumvent both national and international obstacles to generic medicine production. Our proposal has three key features: (1) it is prospective in scope, (2) it facilitates unfettered generic competition in poor countries, and (3) it centers around universities and their role in the biomedical research enterprise. Two characteristics make universities ideal agents of the type of open licensing proposal described. First, universities, because they are upstream in the development pipeline, are likely to hold rights to the key components of a wide variety of end products. Second, universities acting collectively have a strong negotiating position with respect to other players in the biomedical research arena. Finally, counterarguments are anticipated and addressed and conclusions are drawn based on how application of the Equitable Access License would have changed the effects of the licensing deal between Emory and Gilead.

Quantifying the Benefits of Primary Care Physician Supply in the United States

Quantifying the Benefits of Primary Care Physician Supply in the United States
International Journal of Health Services, Vol. 37 no. 1, pp. 111-126

Macinko, J., B. Starfield, L. Shi
01/01/2007

This analysis addresses the question, Would increasing the number of primary care physicians improve health outcomes in the United States? A search of the PubMed database for articles containing "primary care physician supply" or "primary care supply" in the title, published between 1985 and 2005, identified 17 studies, and 10 met all inclusion criteria. Results were reanalyzed to assess primary care effect size and the predicted effect on health outcomes of a one-unit increase in primary care physicians per 10,000 population. Primary care physician supply was associated with improved health outcomes, including all-cause, cancer, heart disease, stroke, and infant mortality; low birth weight; life expectancy; and self-rated health. This relationship held regardless of the year (1980-1995) or level of analysis (state, county, metropolitan statistical area (MSA), and non-MSA levels). Pooled results for all-cause mortality suggest that an increase of one primary care physician per 10,000 population was associated with an average mortality reduction of 5.3 percent, or 49 per 100,000 per year.

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