The Doctor Interactive Group Medical Appointment (DIGMA) is a group health intervention that combines the services of behavioral health and primary care. The DIGMA was first invented by Edward Noffsinger in 1996, in response to his own difficulties with the overtaxed primary care system at Kaiser Permanente in California (Noffsinger, 1999). Integrating healthcare services in this way has practical implications such as efficient use of resources, treating multiple complaints at once, and beginning to view the mind and body as one (Noffsinger, 1999; Engel, 1977). The DIGMA at the Austin Veterans Outpatient Clinic was designed to address the specific needs of veterans with hypertension. It consists of 4 sessions of 1.5 hours each and addresses such varied topics as exercise, stress-management, nutrition, and medication adherence. These topics are discussed in a group format with the tenets of group psychotherapy (Yalom & Leszcz, 2005) as a backdrop. An exploratory study was warranted to determine whether programs of this sort would be effective on a broad scale. A pretest/posttest design was utilized to determine if the DIGMA was effective at reducing symptoms of hypertension; improving health promoting behavior; increasing self-efficacy to manage hypertension; and increasing internal health locus of control while decreasing chance and powerful others health locus of control. Groups were conducted over a period of seven months with a total of 73 male veterans enrolled in the study. The final n was 58. Findings indicated that both systolic and diastolic blood pressure readings were reduced significantly from pretest to posttest. Health promoting behavior increased significantly; hypertension self efficacy increased significantly; and locus of control did not change significantly from pretest to posttest. The exploratory study concluded that the DIGMA may be efficacious for a variety of aspects of the management of hypertension. It is suggested that further research be conducted but that integrating services in this way can lead to improved patient outcomes and can also be cost-effective. / text

Black women in the United States have a high prevalence of hypertension and suffer the most complications of cardiovascular disease. Black women, though aware of the dangers associated with hypertension, have limited opportunity to access health care and or change their lifestyles. The purpose of this quantitative cross-sectional study was to test if there was a significant difference in hypertension awareness, health care access/use, and lifestyle modifications in Black women prior to and post implementation of The Patient Protection and Affordable Care Act, as compared to women of other races. The behavior modification theory guided this study. Secondary data from the National Health Interview Survey for the years 2009 to 2013 for women ages 20 - 65 were analyzed using logistic regression analysis. According to the study results, there was no association (p values > 0.05) among variables age, education, income, length of employment, and hypertension awareness, health care access/use, and life style modification among Black women in the United States, as compared to women of other races. The findings from this study may allow researchers and policy makers to develop more culturally significant health services for Black women. These findings could create positive social change by targeting programs that promote hypertension awareness leading to effective lifestyle changes in Black women.

Questa tesi include tre capitoli che si concentrano sulle politiche pubbliche e la tutela della salute. Il primo capitolo esamina l’effetto dell’incremento delle aliquote dell’IVA su alcune bevande sul loro consumo. I risultati dell’analisi empirica suggeriscono che l'aumento dell'aliquota IVA ha ridotto il consumo di alcolici, birra e bevande gassate, mentre l’effetto sul consumo di vino non è statisticamente significativo. Tuttavia, questo risultato generale cambia se si considerano sotto-gruppi di individui. Il secondo capitolo studia l’impatto del salario minimo sulla salute della popolazione cinese. Le stime indicano che i salari minimi reali sono negativamente e significativamente correlati con lo stato di salute della popolazione sia nel breve che nel lungo periodo, un risultato che potrebbe essere spiegato dalle condizioni di lavoro più stressanti conseguenti all’introduzione di un salario minimo più elevato. Infine, il terzo capitolo analizza gli effetti dei meccanismi di incentivazione sui comportamenti degli operatori sanitari del settore delle cure primarie nell’ambito della gestione dell'ipertensione. La nostra indagine empirica suggerisce che gli incentivi finanziari negativi potrebbero motivare gli operatori sanitari a migliorare la qualità dei servizi legati alla gestione dell'ipertensione, mentre né gli incentivi finanziari né diverse modalità di valutazione delle prestazioni sembrano influenzare la qualità dei servizi. / This dissertation includes three chapters which focus on the relationship between public policies and healthcare. The first chapter examines whether tax policy is effective in changing the unhealthy drinking behaviours of individuals. My findings suggest that the VAT rate increase is effective in reducing the consumption of spirits, beer and carbonated beverages, while it is not effective for wine. However, this general result change when looking at sub-groups of individuals. The second chapter studies how real minimum wages affect population health in China. I conclude that real minimum wages are negatively and significantly related to population health, a result which might be explained by the role of more stressful working conditions as a consequence of a higher minimum wage. Finally, the third chapter analyses the effects of incentive mechanisms on the behaviours of primary health workers and the subsequent effects on the quality of hypertension management. The empirical investigation suggests that negative financial incentives could motivate primary health workers and improve the quality of hypertension management. However, neither positive financial incentives nor different modes of performance evaluation are significantly related to the quality of hypertension management.