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The Affordable Care Act (ACA) seeks to increase the low-income population’s access to health care coverage by expanding Medicaid eligibility and providing subsidies to individuals meeting certain income thresholds. The citizens of Texas would benefit greatly from the ACA provisions, as the state offers limited opportunities for individuals to access insurance, evidenced by the 6.3 million residents without health care coverage. But political leaders in Texas have a long-standing commitment to limited government, low taxes, and states’ rights in a federal system of government. In the 1990s, Texas legislators, with bipartisan support, laid the groundwork over the last decade for the minimal, yet significant preparations that administration used to coordinate ACA implementation. Yet legislators’ commitment to limited government and states’ rights placed additional constraints on the ability of the Texas Health and Human Services Commission (HHSC) to implement ACA provisions by refusing to utilize the 82nd legislative session to prepare the state for impending deadlines. Instead, administrators developed an interagency effort, the Eligibility Modernization Project (EMP), to streamline eligibility determinations and increase clients’ access to information and services. EMP’s initiatives mirror ACA provisions, but also seeks to achieve policy goals that both Republican and Democratic legislators support, such as providing effective and efficient eligibility determinations. Nevertheless, legislators and administrators must go beyond EMP’s efforts to adequately prepare the eligibility system for impending ACA deadlines. Policy recommendations include further streamlining and integrating the health subsidy system with a state-based health insurance exchange, increasing access to coverage by expanding Medicaid eligibility, adequately preparing the workforce for changes, and promoting long-term planning. These solutions will provide a sounder infrastructure for HHSC to prepare for ACA coordination and implementation, while increasing access to health care coverage for the low-income population. / text

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Social determinants of health (SDOH) are often used to discuss health inequities and systemic barriers experienced by minority populations. In the United States, the intersection of SDOH leaves these populations vulnerable to negative health outcomes. Missing from the SDOH discourse are the underlying historical causes for these disparities. Medical-Legal Partnerships (MLPs) have undertaken the role of educating the health and human services (HHS) workforce on interdisciplinary collaboration, cultural competence, and the skills to recognize experiences of negative SDOH. However, current research does not explore the foundational impact of historical trauma, more specifically Post Traumatic Slave Syndrome (PTSS), on experiences of negative SDOH. This ethnography primarily uses the personal accounts of black female HHS workforce members and participant observation from within a MLP to examine how historical trauma acts as a foundation for understanding the complex interactions of SDOH. The SDOH discourse does not challenge the medical and legal institutions that contribute to how minority populations experience negative SDOH. As currently structured, MLPs unintentionally reproduce a pedagogical narrative that erases the lived experiences of SDOH by only focusing on individual factors and not systems. Black female HHS workforce members agree that historical context is missing (e.g. PTSS) from the SDOH discourse and contemporary experiences of racism and discrimination. Historical context would change how HHS workforce members advocate for their patients as well as engage in system-challenging praxis within the medical and legal institutions. This suggests the need to examine how American institutions exclude particular histories and reinforces a white supremacist and patriarchal narrative.

A global epidemic of metamorphosed, conglomerated health care systems changed the face of public health care organizations. The problem is, public health care organizations merge into new systems, but the culture for each merged organization has not been formed under the new system. Public administrators, health care workers and the Department of Health and Human Services are affected when there are issues in health care behavioral practices and performance outcomes. Research found that employee motivation is hard to achieve when there are issues within the internal structure of a new system. Using Herzberg's motivation-hygiene and Tajfel and Turner's social identity theories as the foundation, the purpose of this correlational study was to examine the statistical relationship between growth opportunities, organizational culture, monetary compensation and employee motivation. Secondary data were used from a sample of 3,033 health care workers from 2 English hospitals in the United Kingdom. The data were examined using Point-Biserial Correlation Coefficient model statistical t test. The study's results concluded that growth opportunities, organizational culture, and monetary compensation significantly correlate with employee motivation. Recommendations included implementing systematic changes to the internal organizational structure by identifying and developing effective strategies to improve internal organizational practices and performance outcomes. Further research is needed for demographic comparisons. The study affects social change by informing the Department of Health and Human Services, health care organizations and public health administrators of various strategies that can be used to improve internal organizational practices performance outcomes.

This study proposed a look at the importance and challenges of knowledge management in times of great change. In order to understand the information phenomena of interest, impacts on knowledge workers and knowledge documents in times of great organizational change, the study is positioned in a major consolidation of state agencies in Texas. It pays special attention to how the changes were perceived by the knowledge workers by interviewing those that were impacted by the changes resulting from the reorganization. The overall goal is to assess knowledge management in times of great organizational change by analyzing the impact of consolidation on knowledge management in Texas's Health and Human Services agencies. The overarching research question is what happened to the knowledge management structure during this time of great change? The first research question was what was the knowledge worker environment during the time of change? The second research question was what was the knowledge management environment of the agencies during the time of change? The last research question was did consolidation of the HHS agencies diminish the ability to transition from tacit to explicit knowledge? Additionally, the study investigates how the bill that mandated the consolidation was covered in the local media as well as the actual budget and employee loss impact of the consolidation in order to better understand the impacts on knowledge workers and knowledge documents as a result of major organizational restructuring. The findings have both theoretical and practical implications for information science, knowledge management and project management.

Thesis (MPH.) -- University of Limpopo, 2021 / Background: Achieving high vaccination coverage is crucial in the control, prevention and elimination of childhood vaccine preventable diseases. The Expanded Program of Immunization (EPI) aims for 95% coverage for each antigen and complete vaccination schedules for 90% of children under 12 months of age. All the vaccines included in the national vaccination schedule (Bacille Calmette Guerin (BCG), Oral Polio Vaccine, Diphtheria-Pertussis-Tetanus (DPT) vaccine, Measles and Hepatitis B vaccine are provided free of charge in the primary health services in South African public health care facilities. Although the coverage of all vaccines in South Africa has increased especially in recent years, the EPI targets has not been achieved yet in some parts of the coutnry and there are still differences within provinces. Therefore, the primary objective of this study was to investigate the prevalence and determinants of childhood immunization coverage at Primary Healthcare facilities, Bushbuckridge, sub district of the Mpumalanga Province, South Africa. The mean age of the children was 1.4±2.5 years (ranged: 1 months to 12 years. Slightly more than half (56%) of the children were less than 6-months. Nearly two-thirds (63%) of the children were females and only 37% were males. Methodology: A cross-sectional descriptive study was conducted among selected Primary Healthcare facilities in Ehlanzeni District, Bushbuckridge Sub- district, Mpumalanga Province. Simple random sampling was used to get a minimum sample size of 426 mothers and/or caregivers paired with their children required for the study. The researcher administered a validated or tested self-designed questionnaires to the participants. Data analysis was done using the STATA statistical software version 12 for Windows (STATA Corporation, College Station, Texas). Results: The mean age of the participants was 34.1±9.2 years ranged from 15 to 57 years. Almost one-third (28.6%) of the mothers and/or caregivers were 40 years and older and the majority (70%) were unmarried. Majority of the participants had secondary ix education with 65.5% and 23.4% had primary education. Nearly eighty per cent (79.2%) of the maternal and/or caregivers were unemployed. The prevalence rate of fully immunized children was 88% and a significant higher proportion of children in the age group 12 years at 57% were likely not to be fully immunized (p<0.05), followed by age group 6 -11 years, 18 months – 5 years, 6-8 months and 9-11 months at 48%, 26%, 17% 13% respectively. No statistical significant relationship was found between maternal and/or caregiver age, marital status, level of education, employment status and immunization coverage of the child. However, participants aged 40 years and older, less educated and unemployed were likely to have missed immunization of their children. Mother and/or caregivers with a tertiary education were 3.46 times more likely to get their children immunized than those with none/primary education [OR = 3.46, (95% CI:0.75;15.9), p<0.2)]. The employed mother and/or caregivers were 2.01 times more likely to get their children immunized than the unemployed mother and/or caregivers [OR = 2.01, (95% CI: 0.82; 4.89), p<0.20]. In the multivariate model, level of education and employment status were found not to be significantly associated with immunization of the child. Conclusion: The overall immunization coverage in the present study was relatively high and significantly decreased with age. At 6 weeks, all age groups between 0-6 weeks were immunized, while at 10 weeks, with exception of children in the age group 10 -13 weeks and 18 months – 5 years. At 6 months, the young children (age 9-11 months) were likely to default or missed measles vaccination. At 6 and 12 years, the Td vaccination coverage was relatively low. Mothers and/ or caregivers who missed child immunization were likely to experience shortage of vaccines at health facility and said it takes the whole day to immunize a child but the result were not significant. Mother and/or caregivers with a tertiary education and employed were more likely to immunize their children than mothers and/or caregivers with primary, secondary education and the unemployed.

Indiana University-Purdue University Indianapolis (IUPUI) / Oral health is crucial to overall health and a focus of the U.S. Health Center program, which provides preventive dental services in medically underserved communities. Dental hygiene is an oral health profession whose practice is focused on dental disease prevention and oral health promotion. Variations in the practice and regulation of dental hygiene has been demonstrated to influence access to dental care at a state level; restrictive policies are associated lower rates of access to care. Understanding whether and to what extent policy variations affect availability and access to dental care and the oral health of medically underserved communities served by grantees of the U.S. Health Center program is the focus of this study. This longitudinal study examines dental service utilization at 1,135 health center grantees that received community health center funding from 2004 to 2011. The Dental Hygiene Professional Practice Index (DHPPI) was used as an indicator of the state policy environment. The influence of grantee and state level characteristics are also considered. Mixed effects models were used to account for correlations introduced by the multiple hierarchical structure of the data. Key findings of this study demonstrate that state policy environment is a predictor of the availability and access to dental care and the oral health status of medically underserved communities that received care at a grantee of the U.S. Health Center program. Grantees located in states with highly restrictive policy environments were 73% less likely to deliver dental services and, those that do, provided care to 7% fewer patients than those grantees located in states with the most supportive policy environments. Population’s served by grantees from the most restrictive states received less preventive care and had greater restorative and emergency dental care needs. State policy environment is a predictor of availability and access to dental care and the oral health status of medically underserved communities. This study has important implications for policy at the federal, state, and local levels. Findings demonstrate the need for policy and advocacy efforts at all levels, especially within states with restrictive policy environments.