Global ETD Search

241	State income tax a double-edged sword Burgos, Karla 01 December 2011 (has links) States are facing tough economic times as a result of the housing market bubble exploding. States have been declaring budget deficits and major program cuts, since revenues have not kept up with expenditures and rainy day funds have been practically exhausted. State tax revenues have decreased, resulting from a decline in income tax revenues, one of the major sources of revenues for a large number of states (41 in total). A majority of these states have come to depend heavily on the revenue they collect from income taxes, which can represent as much as 40% of state tax revenue. This thesis focuses on the impact that income tax revenue has on state budgets and how it affects certain expenditures. To provide a more complete understanding on how fiscal policy affects the citizen directly, this thesis compares the changes in state's total tax revenue and spending on education and health programs between states that levy income tax and states that do not. Data from the United States Census Bureau and the National Association of State Budget Officials was analyzed by calculating the growth rate and relevant elasticities during 2006-2010, the years before, during, and after the last recession. Results will show a difference in changes in revenue and expenditure between the two types of states and a more sensitive elasticity for non-income tax states for both revenue and expenditure. With a better understanding of how the tax base behaves and how revenue affects programs, an improved tax policy that could produce more efficient services for citizens might be created. Economics
242	Equitable access to maternity care practices that promote high-value family-centered intrapartum care Frost, Jordana 23 October 2018 (has links) BACKGROUND: Despite large investments in maternity care services, perinatal health outcomes in the U.S. are among the worst compared to other industrialized countries, with documented perinatal health disparities disproportionately impacting racial and ethnic minorities. Midwifery-led freestanding birth centers (FSBC) have emerged as an underutilized model for the safe and cost-effective care of women with low-risk pregnancies. Despite approximately 85% of all US pregnancies being considered low-risk, only 0.5% of all US births occurred in a FSBC in 2016. The goal of the study is to elucidate strategies used to develop and sustain freestanding birth centers (FSBCs) that are seeking to serve high proportions of publicly-insured women and women of color. METHODS: I conducted an embedded unit case study, including semi-structured in-depth interviews and focus groups with 49 stakeholders from three exemplary FSBCs. Supplemental interviews were led with five key informants from three additional FSBCs and a relevant national membership organization. Additional data sources used to complete this case study include, where relevant and permitted, observations of maternity care settings, patient-provider encounters, management meetings, community events, and review of pertinent documents. Qualitative analysis methods were used to identify common themes and variations. FINDINGS: Midwifery-led birth center care can improve the experience and outcomes of maternity care among publicly insured women of color. The study revealed persistent multi-level challenges, as well as the use of common approaches to overcome these organizational, financial, and cultural barriers, resulting in greater, yet still fragile, access to family-centered intrapartum care within the communities in which these FSBCs operate. CONCLUSIONS: The careful integration of FSBCs into health systems such as a Federally Qualified Health Center (FQHC) may contribute to the broad scale-up of this underutilized model of care. While integrating FSBCs into FQHCs may be helpful in expanding equitable access to birth center care, it is not necessary, and also not sufficient. Expansion efforts should include additional deliberate processes and strategies to ensure equitable uptake and sustainability of birth center care. / 2020-10-23T00:00:00Z Public health Birthing center Childbirth Federally qualified health center Free-standing Intrapartum Maternity Medicaid Midwifery Perinatal health disparities Prenatal Triple aim Ambulatory care Maternal health Patient-centered Racial equity
243	The Politics of Medicaid Contracting and Privatization Randall, David J. 20 June 2012 (has links) No description available. Health Care Health Care Management Political Science Public Administration Public Health Public Policy Medicaid entitlements interest groups state policymaking state bureaucracy bureaucratic capacity contracting privatization health policy managed care
244	The nursing home five star rating: How does it compare to resident and family views of care? Williams, Anthony R. 18 October 2012 (has links) No description available. Aging Health Care Public Policy Long-Term Care LTC Nursing Home Quality Domains Quality Ratings Quality Nursing Home Compare NHC Star Ratings CMS Resident Satisfaction Family Satisfaction Consumer Satisfaction Consumer Guide Ohio
245	Navigating the Health Care Labyrinth: Portraits of the Socioeconomically Disadvantaged Crawford, Thomas C. 05 February 2014 (has links) No description available. Health Care Health Care Management health care access commercial insurance discrimination emergency department disparities labyrinth outcomes socioeconomic status social class uninsured underinsured portraiture phenomenology
246	美國《病人保護暨可負擔醫療法》之研究 / A study on American “Patient Protection and Affordable Care Act” 李照華, Li, Jhao Hua Unknown Date (has links) 美國前總統歐巴馬於2010年簽署之法案「病人保護暨可負擔醫療法」（Patient Protection and Affordable Care Act, PPACA）又稱「歐巴馬醫療法」（Obamacare），主要目的之一在於提升對人民醫療照顧的保障，擴大人民的醫療照顧覆蓋面，並讓醫療保險成為可負擔的，具體改革面向主要在公共醫療照顧的範圍擴大、對人民強制納保規定，與對於商業醫療保險之各種規制，而從歐巴馬醫療法內容中，得以探討美國如何在維持既有醫療照顧體系架構、商業醫療保險為主導的模式中，透過對商業醫療保險的規制來成就相當於社會保險所實現的社會安全，並與我國作比較，雖然主要採取之醫療照顧模式不同，但同樣在促成全民納保的社會國目的之達成，兩國背後的立法背景、操作上有何異同，以及會遇到之爭議與困境何在，並且進一步思考是否有讓我國在處理目前制度問題的值得參考之處。本文先論述美國傳統對於醫療照顧的心態與背景，並介紹美國的醫療照顧制度與衍生的問題，並從中了解醫療照顧之相關權利、全民納保觀念在美國的發展狀況，接著介紹歐巴馬醫療法的發展過程與實際內容，聚焦在擴大醫療照顧覆蓋面與令醫療保險成為可負擔之相關規定，並了解幾個重要的聯邦最高法院對歐巴馬醫療法之違憲審查判決中對爭議的處理，之後觀察歐巴馬醫療法如何透過對商業醫療保險的規制來讓其能成就社會安全功能，並追蹤後續歐巴馬醫療法實施後之成效與未來可能變化。對照我國，在介紹我國全民健康保險之發展與內容後，比較兩國在促成全民納保的背景、立法與釋憲過程中的爭議為何且如何處理、全民納保的操作內容，以及醫療照顧相關權利的承認與否、商業醫療保險的角色等，也從中討論是否有我國在解決現今全民健保之問題上可參考之面向。病人保護暨可負擔醫療法歐巴馬醫療法醫療照顧醫療保險醫療救助聯邦醫療保險醫療人權健康權 Obamacare Health care Health insurance Medicaid Medicare Right to health care Right to health
247	Geospatial Approaches to Social Determinants of Cancer Outcomes Dong, Weichuan 19 November 2021 (has links) No description available. Epidemiology Geography Geographic Information Science Health Health Care Health Care Management Oncology Public Health Public Policy Statistics geography geographic information science geographic information systems social determinants of health machine learning spatial statistics spatial epidemiology breast cancer late-stage cancer classification and regression tree random forest geographic random forest space-time scan statistic SaTScan Medicaid expansion health disparity
248	The Implementation of a State Monitoring and Surveillance Program: What Factors Influence the State Policy? Lawrence-Jackson, Kywaii K 15 December 2012 (has links) This study examines state variations in health care services for children with Autism and other developmental disabilities across the fifty states through the Autism and Developmental Disabilities Monitoring Network (ADDM). The ADDM network monitors and tracks the number of children with Autism and other developmental disabilities. The purpose of this study is, first, to understand the differences between the states in the implementation of the ADDM network and, second, to determine what state factors (political variable, i.e., party identification; structural administrative variables, i.e., Medicaid Home and Community Based Service Waiver, HCBS (Section1915C) and the number of pediatricians per 10,000 children; Autism prevalence variable, i.e., Autism among children in special education per 10,000 children; and state economic variables, i.e., spending per pupil for children with Autism in special education, children in poverty, and state financial health) influence the likelihood of a state applying for the ADDM network. Furthermore, the purpose of this study is to consider the potential impact of these various state characteristics in order to understand what state factors might contribute to such differences. The results reveal that structural administrative and economic factors influence a state’s decision to apply for the ADDM network. Furthermore, political factors (e.g., Democratic party control of governorship and legislature) did not influence a state’s decision to apply for the ADDM network. However, when controlling for Republican political party identification, the structural administrative, economic, and political (Republican-controlled legislature) state characteristics influence whether a state applying for the ADDM network. The results indicate that political party control does not play a significant role in determining whether a state will apply for the ADDM network. In expanding the research, to include another structural administrative factor (prior application), political party control (i.e., Republican-controlled legislature) was no longer significant. Thus, the bureaucratic environment is not influencing the actions of state administrators. Instead the individual characteristics of the state is influencing whether a state will apply for the ADDM network. Understanding the differences between the states in the implementation of the ADDM network provides a comprehensive model for establishing the ADDM network or similar programs in other states. health care spending per capita child poverty Autism prevalence pediatricians children with Autism political party identification health care services monitor and track (surveillance)
249	Mitigating fraud in South African medical schemes Legotlo, Tsholofelo Gladys 10 1900 (has links) The medical scheme industry in South Africa is competitive in relation to international standards. The medical scheme sector, as part of the healthcare industry, is negatively affected by the high rate of fraud perpetrated by providers, members and syndicates, which results in medical schemes funding fraudulent claims. The purpose of the study was to explore strategies to mitigate fraud in medical scheme claims. A qualitative research methodology was followed in this study, which adopted a case study approach. Empirical data was analysed through thematic analysis, with the aid of ATLAS.ti software. The study found that healthcare service providers mainly defraud medical schemes by submitting false claims. A holistic approach should be followed to mitigate fraud in medical scheme claims. This approach should encompass regularly identifying trends in fraudulent claims and implementing appropriate control strategies. Collaboration within the medical scheme industry and with other stakeholders would also help to elevate the fight against medical scheme fraud to a new level. Implementing the recommendations from the study will assist medical schemes to reduce the funds expended on fraudulent claims, thereby improving their financial viability and decreasing the rate of increase in medical scheme contributions for members. / Business Management / M. Com. (Business Management) South Africa Healthcare Medical schemes Fraud Healthcare fraud Operational risk Qualitative Case study Thematic analysis ATLAS.ti Risk mitigation 658.4730968 Fraud -- South Africa Fraud -- South Africa -- Prevention Forensic accounting -- South Africa Risk management -- South Africa Fraud investigation -- South Africa
250	Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital Lucas, D. Pulane 24 April 2013 (has links) Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs. Disruptive Disruptive Innovation Theory Disruptive Transformations Disruptive Innovation Innovation Technology Technological Innovation Medical Innovation Medical Technology Medical Advancement Laparoscopy Laparoscopic Surgery open surgery appendectomy cholecystectomy bariatric surgery weight loss surgery appendectomies cholecystectomies inpatient outpatient ambulatory ambulatory surgery ambulatory surgery center acute care general hospital hospital acute care hospital general hospital health care healthcare hospital industry health care industry Clayton Christensen Clayton M Christensen Michael Porter Harvard Business School Virginia Commonwealth University CMS Health policy public policy public administration organizational theory organization theory Population Ecology Theory Competitive Strategy policy analysis John Kimberly Organization Size Structural Inertia liability of smallness health spending health care cost specialty medical facility open system niche width dynamic outpatient department technology shift surgical setting surgical setting shift medical facility shift substitution threat health system system level analysis Ecological Approach hospital trends ambulatory surgery trends reimbursement rate Medicare CMS coverage decision P J DiMaggio DiMaggio and Powell w w Powell Hannan and Freeman M T Hannan Organizational change minimally invasive surgery less invasive surgery Prospective Payment System Outpatient Prospective Payment System entreprenuerial physician health care organization health care management Roice Luke Carl Ameringer new technology surgical utilization elective surgery Medicare Payment Advisory Commission MedPAC coverage decision trends in surgery abdominal surgery surgical variation physician-owned physician ownership physician autonomy outpatient clinic utilization trends unnecessary surgery Pfeffer Salancik technology diffusion redefining health care interdisciplinary research health care delivery panel design diffusion of hospital technology state variation regional variation local health care market government intervention medical facility health care capacity focused factory advances in health care physician organization relationship hospital competition medical specialization hospital expansion medical arms race integrated care integrated health system J E Wennberg health care transformation reimbursement scheme surgical volume Florida Wisconsin policy making health policy analysis competitive dynamics center of excellence intervening factor service line competition service-line competition surgical reimbursement innovative business model innovative technology environmental influence established firm new market entrant patient safety sophisticated technology Harvard Divinity School Social and Behavioral Sciences

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