Magister Scientiae - MSc (Pharmacy Administration and Policy Regulation) / Technological advancements applied to healthcare may holistically improve the economic burden of prescription medication costs. United States legislative actions requiring utilization of electronic prescribing (e-prescribing) will drive provider utilization to decrease healthcare spending. Federal and state e-prescribe requirements have been met with resistance by the prescribing community, due to claims that the requirements create an economic burden for them. This research intends to demonstrate the long-term economic value of electronic prescribing regulations across the healthcare spectrum.

This thesis is concerned with determining whether South African mental health law and its application in practice is in need of reform. In order to reach its objectives, the thesis measures mental health legislation and criminal law that affect the mentally ill individual or offender against international and local human rights standards, and generally accepted principles and scientific principles applicable in the mental health profession. Particular focus is placed on the admission of a mentally ill person as a voluntary, assisted or involuntary mental health care user, State Patient or mentally disordered prisoner in terms of the Mental Health Care Act 17 of 2002 (?MHCA?), as well a critical review of the MHCA forms used to translate the Act?s provisions into practice. The thesis critically discusses the regulation of mental health care practitioners in terms of the Health Professions Act 56 of 1974, including psychology and psychiatry and the expert witness, and the new Traditional Health Practitioners Act 22 of 2007 and its regulations. An outline of the role of the National Health Act 61 of 2003 in the administration of the health system is provided.The thesis analyses the manners in which mental health affects criminal liability, and Chapter 13 of the Criminal Procedure Act 51 of 1977. Finally a desktop study into the current state of mental health care provision and the implementation of legislation in practice is conducted, followed by conclusions and recommendations for reform to legislation, policy, and the MHCA forms where anomalies have been identified. / Thesis (LLD)--University of Pretoria, 2016. / Public Law / LLD / Unrestricted

In the U.S., the healthcare sector is highly regulated -- government regulation touches almost every dimension of healthcare, from health insurance to pharmaceuticals to medical services. The healthcare sector and the policies that govern it present an interesting setting to study many classic questions in public economics: how does regulation interact with or change individual and firm behavior? How do you monitor third parties who decide how to spend public funds? What happens when policy changes spill over from one segment of the economy to others? The three papers in this dissertation seek to answer these questions via the lens of the U.S. healthcare system. The first paper, "Job Lock, Retirement, and Dependent Health Insurance: Evidence from the Affordable Care Act,'' considers the extent to which changes in policies governing health insurance spill over onto individual labor market decisions. In particular, it looks at whether parents with young adult children eligible for the Affordable Care Act's dependent mandate delayed retirement to take advantage of the mandate. The second paper, "Regulated Revenues and Hospital Behavior: Evidence from a Medicare Overhaul'' (with Tal Gross, Adam Sacarny, and David Silver), considers how healthcare providers respond to changes in regulated prices. In it, we study a major reform that increased Medicare prices for some hospitals but decreased them for others, and consider how hospitals responded to these payment changes. Finally the third paper, "The Costs and Benefits of Monitoring Providers: Evidence from Medicare Audits,'' studies the efficacy of policies aimed at monitoring healthcare providers for wasteful expenditure. It studies a large monitoring program run by Medicare, and estimates the costs and benefits of this monitoring for the government, providers, and patients.

Health insurance literacy (HIL) contributes to the lack of understanding basic health insurance (HI) terms, subsidies eligibility, health plan selection, and HI usage. The study is one of few to address the existing gap in the literature regarding the exploration of the relationship between HIL, individuals' HI enrollment, and individuals' satisfaction with their HI. The theoretical framework selected for this study was the prospect theory, which describes the behavior of individuals who make decisions. In this cross-sectional correlational study, secondary data set from the third Quarter 2015 Health Reform Monitoring Survey was used. Binary logistic regression models were used to test hypotheses of four predictive relationships between (a) HI enrollment and HIL with HI terms; (b) marketplace enrollment and HIL with HI terms; (c) satisfaction with HI and HIL with HI access to care; and (d) satisfaction with HI and HIL with HI cost of care. Results indicated that participants with high HIL with HI terms had 4.2 times higher odds that those with low HIL to be enrolled in HI and 81% higher odds than those with low HIL to be enrolled in marketplace HI. The most significant relationship indicated that participants with high HIL with HI activities had 12.8 times higher odds than those with low HIL to have high satisfaction with access to care and 8.8 times higher odds than those with low HIL participants to have high satisfaction with cost of care. The finding that low HIL is associated with lower enrollment and lower satisfaction with HI has implications for social change. Policymakers may have the opportunity to utilize this study to promote policies that promote higher HIL, which may lead to increased HI enrollment and improved satisfaction with HI selection.

With the passage of the Affordable Care Act, states were given the option to expand their Medicaid programs. Since then, thirty-eight states and Washington, D.C., have done so. Previous work has identified the widespread effects of expansion on enrollment and the financial implications for individuals, hospitals, and the federal government, yet administrative expenditures have not been considered. Using data from all fifty states for the period 2007-17, our study estimated the effects of Medicaid expansion overall, as well as differing effects by the size and nature of the expansions. Using a quasi-experimental approach, we found no overall effect of expansion on administrative spending. However, the size of the expansion may have produced differing effects. States with small expansions experienced some increases in administrative spending, whereas states with large expansions experienced some decreases in administrative spending, including a $77 reduction in per enrollee administrative spending compared with nonexpansion states. As more states consider expanding their Medicaid programs, our findings provide evidence of potential effects.

This dissertation continues the tradition of identifying the unintended consequences of the US health insurance system. Its main contribution is to estimate the size of the distortions caused by the employer-based system and regulations intended to fix it, while using methods that are more novel and appropriate than those of previous work. Chapter 1 examines the effect of state-level health insurance mandates, which are regulations intended to expand access to health insurance. It finds that these regulations have the unintended consequence of increasing insurance premiums, and that these regulations have been responsible for 9-23% of premium increases since 1996. The main contribution of the chapter is that its results are more general than previous work, since it considers many more years of data, and it studies the employer-based plans that cover most Americans rather than the much less common individual plans. Whereas Chapter 1 estimates the effect of the average mandate on premiums, Chapter 2 focuses on a specific mandate, one that requires insurers to cover prostate cancer screenings. The focus on a single mandate allows a broader and more careful analysis that demonstrates how health policies spill over to affect the labor market. I find that the mandate has a significant negative effect on the labor market outcomes of the very group it was intended to help. The mandate expands the treatments health insurance covers for men over age 50, but by doing so it makes them more expensive to insure and employ. Employers respond to this added expense by lowering wages and hiring fewer men over age 50. According to the theoretical model put forward in the chapter, this suggests the mandate reduces total welfare. Chapter 3 shows that the employer-based health insurance system has deterred entrepreneurship. It takes advantage of the natural experiment provided by the Affordable Care Act's dependent coverage mandate, which de-linked insurance from employment for many 19-25 year olds. Difference-in-difference estimates show that the mandate increased self-employment among the treated group by 13-24%. Instrumental variables estimates show that those who actually received parental health insurance as a result of the mandate were drastically more likely to start their own business. This suggest that concerns over health insurance are a major barrier to entrepreneurship in the United States. / Economics

Managed care plans purport to improve the health of their members with chronic diseases. How has the growing adoption of Medicare Advantage (MA), the managed care program for Medicare beneficiaries, affected the progression of chronic disease? The literature is rich with articles focusing on managed care organizations' impacts on quality of care, access, patient satisfaction, and costs. However, few studies have analyzed these impacts with respect to market penetration of Medicare managed care. The objective of this research has been to analyze the relationships between the market penetration of MA plans and the progression of chronic diseases among Medicare beneficiaries. The Chronic Disease Severity Index scale (CDSI) was constructed to represent beneficiaries' overall chronic disease states for survey or claims-based data, when more direct clinical measures of disease progression are not available. Using the CDSI on the MEPS survey dataset from AHRQ, we sought to assess the impacts of MA market penetration and other covariates on the overall chronic disease state of Medicare beneficiaries from 2004 through 2008. Though the model explains much of the variation in CDSI change, the author expected the multilevel model would show that MA penetration explains a significant level of variation in CDSI change. However, this hypothesis was not substantiated, and the findings suggest that unmeasured factors may be contributing to additional unexplained heterogeneity. Policymakers should explore opportunities to refine the current MA program. The MA program costs the federal government more than the Traditional Fee-for-Service Medicare program, and there is no definitive evidence that outcomes differ. Within both programs, there is opportunity to experiment with different models of payment, healthcare service delivery and care coordination. The Patient Protection and Affordable Care Act (ACA) contains provisions for innovative demonstration projects in delivery and payment. The effectiveness of these ACA initiatives must be monitored, both for impacts on health outcomes and for economic effects. This research can inform future approaches to outcomes assessment using the CDSI, and multilevel modeling methodologies similar to those employed here. Firms offering MA health plans would be prudent to proactively demonstrate their value to beneficiaries and taxpayers. They should explore means of better monitoring and reporting the longitudinal outcomes of their enrolled beneficiaries. Demonstrating that they can bring value in terms of improved health outcomes will help insure their long-term survival, both in the marketplace and in the political arena. / Graduation date: 2012

What is lobbying, properly understood, in the United States, and what strategies and tactics—including and especially those determined by contextual factors, as well as firm characteristics—are commonly employed by corporate lobbies as they operate in our American political environments? Considering this, what are the main strategies and tactics employed by the pharmaceutical lobby, with a particular focus on the Pharmaceutical Manufacturers and Researchers of America, or PhRMA? Finally, what roles did PhRMA play in the development and passage of the Obama administration’s Affordable Care Act, and what can this tell us about the lobbying strategies and tactics utilized by one of the most effective lobbies in modern times, as well as about how their strategies and tactics align, or not, with conventional conceptions of lobbying? Through effective use of key lobbying tactics such as direct lobbying and use of public awareness, PhRMA completed one of the more successful lobbying campaigns in recent history. When the White House came calling, they were first to the table, for they knew that with that seat came a position of leverage. From there, they were able to build both political and public support to complete a deal with the Obama administration that they positioned as necessary to keep the Affordable Care Act alive. This deal would ensure that the pharmaceutical industry would pay a flat rate of support for the act, and was therefore guaranteed protection from future government attempts to set or regulate the prices of their products and medicines. PhRMA played the long game, and they played it well.

. Latin@ immigrants face many obstacles to affordable healthcare that push them to disproportionately rely on the primary safety-net for their healthcare needs. This system is mostly funded with public monies that will be significantly reduced when Affordable Care Act is fully implemented. Since undocumented Latin@ immigrants are prohibited from accessing federally funded healthcare, they will be left out of the health care reform. This thesis examines two community-based clinics in the Greater New Orleans area that serve this population, and have developed linguistically and culturally appropriate programs that address its needs. The New Orleans Faith Health Alliance and Common-Ground Health Clinic are cases used to explore the impact that the Affordable Care Act will have in the already unstable safety-net in New Orleans. Through the analysis of other models around the nation, this thesis presents viable recommendations to both clinics and the City of New Orleans Health Department.

Syftet med denna studie är att undersöka hur normer och föreställningar om kön påverkar hur flickor och pojkar beskrivs och gestaltas i 3 § LVU (Lagen med särskilda bestämmelser om vård av unga i vissa fall) domar. Studien är en kvalitativ studie och empirin består av 20 stycken 3 § LVU-domar från Förvaltningsrätterna i Stockholm och Umeå. Domarna berör tio flickor och tio pojkar. Analys av empirin har genomförts med hjälp av diskursanalys samt med teori och tidigare forskning. Resultatet visar att det finns skillnader i hur pojkar respektive flickor beskrivs och gestaltas i 3 § LVU-domar. Pojkar och flickor beskrivs utifrån samhällets normer och föreställningar kring kön, pojkar beskrivs som aggressiva och flickor som sårbara. Sexualitet är något som främst beskrivs i flickornas domar. Studien visar att det har skett en viss förändring över hur flickor och pojkar framställs i 3 § LVU-domar idag jämfört med tidigare, dock finns det fortfarande stora skillnader i diskursen, vilket kräver en samhällelig förändring för att det i grund och botten ska kunna bli jämställt mellan könen. / The purpose of this study is to examine how norms and notions of gender affect how girls and boys are described and portrayed in § 3 LVU (The Compulsory Care Act ) court cases. The study is a qualitative study and the empirical data consists of 20 court cases concerning 3 § LVU from the Administrative Courts in Stockholm and Umeå. The court cases concern ten girls and ten boys. The empiricism has been analysed with a discourse analysis and with previous research and theories. The result shows that there are differences in how boys and girls are described and portrayed in § 3 LVU cases. Girls and boys are described based on prevailing norms and notions of gender that exist in society. Boys are described as aggressive and girls as vulnerable. Sexuality is a subject mainly describes in girl’s court cases. The study shows that there has been some change about how girls and boys are portrayed in 3 § LVU court cases today compared to earlier, however, there are still considerable differences in the discourse, which requires a social change in order for it to be equal between the genders.