acase@tulane.edu

acase@tulane.edu

Research objective. The purposes of this research are to discuss the patterns of catastrophic out-of-pocket payments, to explore the determinants of catastrophic out-of-pocket payments, and to find out the potential impact of introducing user fees for selective services, such as illness and antenatal care, on catastrophic out-of-pocket payments in rural households of Bangladesh Methodology. Data were collected from 5,400 households in selected rural areas of Bangladesh. Out-of-pocket healthcare payment is defined as 'catastrophic' if the ratio of annual per-capita household health expenditure to total annual per-capita household expenditure exceeds a specific pre-defined threshold level. Logit and Tobit models were used for identifying the variables affecting the incidence and intensity of catastrophic out-of-pocket payments. User fees were proposed to recover the cost of providing illness and antenatal care services. Price elasticity and inelasticity approaches with and without options of exemption policies were followed to find out the impact of introducing user fees on catastrophic out-of-pocket healthcare payments Principal findings. The incidence and intensity of catastrophic out-of-pocket payments, as expected, varied widely depending on threshold definition. Age of household head, employment status of household head, household size, per-capita expenditure, and proportion of children aged less than 5 years and reproductive women aged 15-45 years in the household were important in explaining the incidence and intensity of catastrophic out-of-pocket healthcare payments across households in the sample. Introduction of user fees in the health system increased the incidence and intensity of catastrophic out-of-pocket healthcare payments. Exemption policies decreased the incidence and intensity and protected poor households from catastrophic out-of-pocket healthcare payments Conclusions. The findings have policy implications to protect households from catastrophic out-of-pocket healthcare payments. Using the factors affecting the incidence and intensity of catastrophic out-of-pocket payments, it is possible to estimate the risk of catastrophic payment for each type of household. The probability of experiencing catastrophic payment can be used for targeting households for exemptions or for providing subsidized healthcare services. The results suggest that the incidence and intensity of catastrophic payments for healthcare can also be reduced significantly through adopting risk-pooling policies, such as community insurance programs, and enhancing tax collection / acase@tulane.edu

The purposes of this study were (1) to identify the factors present in negligence suits found in case law involving prehospital care providers and (2) based on those factors, to develop a typology of causation of legal actions that could be used by postsecondary educators to emphasize specific areas in the initial training and continuing education of EMTs and paramedics. An additional purpose was to provide data which could be used to develop standards and protocols for quality assurance programs. / Using traditional legal research methods, 182 state and federal cases were identified. It was found that lawsuits involving prehospital care providers and systems have been increasing. A marked increase since 1981 was noted. / Elements of alleged negligence were identified, coded, and ultimately used to develop a typology of causation. The four major categories of causation were, in decreasing order of frequency, (1) treatment and care issues; (2) ambulance accidents; (3) dispatch and transport issues; and (4) other issues, such as training, staffing, and administration. Although alleged treatment and care negligence was the most frequent category, it involved a myriad of types of patient scenarios. On the other hand, the number one most frequent single cause of alleged negligence was ambulance accidents. / Implications of the typology for postsecondary educators, administrators, policy makers, and others were discussed. It was suggested that the typology be used to emphasize and/or alter certain aspects of educational curricula, such as driving skills, assessment skills, spinal immobilization, and others. / Legal precedents set down by the courts were dissected in order to view trends. Precedents, such as, immunity issues, emergency vehicle status, guest statutes, common carrier status, constitutional issues, and duty of care were discussed. The similarities and differences found in case law regarding these precedents were also evaluated. / Source: Dissertation Abstracts International, Volume: 53-03, Section: B, page: 1275. / Major Professor: Louis Bender. / Thesis (Ed.D.)--The Florida State University, 1992.

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<p><bold>Background:<bold> Hospital adoption of health information technology (HIT) systems is promoted as essential to decreasing medical error and their associated 44,000 annual deaths and $17 billion in healthcare costs (Institute of Medicine, 2001; Kohn, Corrigan, & Donaldson, 1999). Leading national healthcare groups, such as the Institute of Medicine, Agency for Healthcare Research and Quality, Institute for Healthcare Improvement, and the Leap Frog Group continue to advocate for increased use of HIT (AHRQ, 2010; Beidler, 2010; Institute of Medicine, 2001; Page, 2003; The Leapfrog Group, 2009), such as provider order entry and electronic health record systems, as a way to improve healthcare quality in hospitals. Even under intense pressure to adopt HIT, however, a mere 2% of US hospitals report having a comprehensive electronic health record system. Further, more than 50% of US hospitals have only rudimentary HIT systems (Jha et al., 2009). With the ARRA HITECH Act of 2009, the pressure on hospitals to quickly adopt HIT and achieve meaningful use is mounting.</p><p>While a large body of literature exists about HIT implementation, the majority is anecdotal case reports. The remaining studies investigated attitudes about HIT or the impact of HIT on patient care processes and outcomes. Thus, best strategies for implementing HIT in hospitals remain unknown. Study design choices, such as the use of self report data, retrospective data collection methods, subjects from single care units or single healthcare professions further limit our understanding HIT implementation in complex hospital care settings.</p><p><bold>Methods:<bold> This prospective, longitutdinal case study used a novel approach, sensemaking, to understanding how project teams may work to implement HIT in an academic medical center. Sensemaking, defined as the social process of establishing the meaning of events and experiences (Weick, 1995), is associated with learning and problemsolving in research studies of healthcare and nonhealthcare settings. Through direct observation and document review I observed project team social interaction and activities over the course of the 18 month preimplementation phase of an HIT implementation project in a single tertiary care hopsital.</p><p><bold>Conclusions:<bold> In this study, I described team actions and activities that enhanced clinician team member sensemaking including: frequent, collective interaction with HIT and focusing team members' attention on specific aspects of HIT function. Further, study findings demonstrated that team members' perceptions of HIT and care processes varied across healthcare professions, management levels, and departments. Supportive social interaction from team leaders and members encouraged team member participation and resulted in members' voicing observations, perceptions and attitudes about the HIT and hospital care processes. Sensemaking of HIT teams not only resulted in identification of needed HIT design changes, but also revealed assumptions and information which may prove critical to successful HIT implementation in hospital care environments. Based on study findings, I suggested strategies for selecting and preparing HIT team members as well as for HIT team activities. This study advanced our understanding of how project teams function and bring about change in complex hospital care environments by not only identifying HIT implementation issues within but also describing the link between team member social interaction and implementation actions.</p> / Dissertation

Thesis (Ph.D.)--Brown University, 2008. / Vita. Advisor : James A. Morone.

Thesis (Ph.D.)--Brown University, 2008. / Vita. Includes bibliographical references.

Thesis (Ph.D.)--Lehigh University, 2009. / Adviser: Shin-Yi Chou.

Not much has changed for the migrant farmworker in the last thirty years. In one of the wealthiest countries on earth, migrant farmworker health status remains comparable to that found in Third World countries because of poor sanitation, poor nutrition and exposure. Current estimates show that migrant clinics are serving less than 20% of this population, leaving about 2,000,000 farmworkers without medical care. The barriers to health care for this population are numerous. This study will focus on the barrier to care resulting from lack of continuity in care due to poor inter-clinic communication. In this study it has been shown that computer disks and a standard word-processing program can be used to create a portable medical health history for the migrant to improve inter-clinic communication. In the process of carrying out this study, it was also shown how other barriers to care for this vulnerable population might be removed as well.