<p> Starting in late 2013, new direct-acting antiviral medicines (DAAs) offered the chance of a cure for chronic hepatitis C virus (HCV) infection. In clinical trials, DAAs helped more than 90% of patients achieve sustained viral response (SVR), commonly considered to be a cure that will stop progression of related liver disease and prevent transmission of the virus to others. Prices for these medicines are now around $20,000 per treatment after discounts from manufacturers, due to competition. </p><p> In late 2016, the medical director for D.C. Medicaid asked what it would take to eradicate hepatitis C in the city. This dissertation focused on that question for Medicaid alone, to inform policy discussions and identify next steps. I profiled beneficiaries with chronic HCV infection based on medical claims from 2014-2016; interviewed medical providers and policymakers to learn more about their decision-making processes and to identify opportunities to expand treatment, as well as potential barriers; and created an Excel-based Markov model that estimates outcomes and costs under different scenarios. </p><p> Only 799 individuals, about 10% of the D.C. Medicaid beneficiaries identified as having chronic HCV infection, received treatment with DAAs in 2014-2016. Providers and policymakers are committed to treating this population, but treatment rates remained low through 2018. I estimate that roughly 80% of Medicaid beneficiaries with chronic HCV had not been treated at the start of 2019. </p><p> Beneficiaries with chronic HCV infection often have other physical, mental, and behavioral health conditions that might keep them from seeking treatment for an often-asymptomatic HCV infection. They often miss scheduled appointments and/or are lost to follow-up. Most live east of the Anacostia River, where there are fewer providers. Even if they engage in care, government or health plan policies might discourage or prevent individuals with low levels of liver damage from getting prior authorization for treatment. </p><p> Broader use of DAAs in D.C. Medicaid will allow more people to achieve SVR, potentially decreasing future healthcare costs for some and saving lives. A moderate (50%) increase in treatment rates among those with low liver damage could enable about 300 additional patients to achieve SVR over 10 years, at a net cost of $6.1 million. A 50% increase in treatment rates among those with moderate liver damage could enable more than 500 additional patients to achieve SVR over 10 years, keep more than 160 from severe liver damage, and avoid 19 early deaths. The net cost of the second scenario is $6.5 million, a smaller increase per person achieving SVR because curing those with moderate liver damage is more likely to avoid high healthcare costs. </p><p> The District must weigh the upfront costs of expanding use of DAAs against uncertain long-term benefits and inherent budget limitations. I recommend that D.C. develop a more complete profile of Medicaid beneficiaries with HCV infection; work toward universal screening and sustained monitoring of at-risk populations; collaborate with key stakeholders to develop policies, practices, and tools to engage beneficiaries in care; and reduce prior authorization requirements that might deter or prevent treatment when beneficiaries and health care providers are ready.</p><p>

Public housing, in growing urban communities like Daytona Beach, Florida is involved in a perpetual struggle for its continued existence. Public housing programs face serious problems in addition to financial difficulties. Many have acquired the reputation of being worse living environments than the slums they were supposed to replace. Although public housing originally served the so called "working poor", it has gradually become the "housing of last resort" for America's poorest citizens. Over the years, it has become obvious that public housing has acquired a rather poor image of being a large conglomeration of low income citizens housed in large impersonal concrete structures. The focus of the study centers on the examination of public housing, its occupants and the negative image that seems to be perpetuated within these lower income areas of cities like Daytona Beach, Florida.

The State Comptroller is an important state official. This research is intended to determine whether method of selection of the state comptroller (election or appointment), organizational configuration of the state comptroller's agency, professional qualifications of the state comptroller, or length of tenure served by the state comptroller have an impact on the effectiveness of the performance of the state comptroller’s agency. This research utilized a multi-constituency model of effectiveness. Under this model, effectiveness was defined as satisfaction of the needs of major constituencies of the state comptroller’s agency. Major constituencies of the state comptroller’s agency were identified. Variables to determine effectiveness for each constituency were also identified. Cross tabulations were prepared that compared the measures of effectiveness for each constituency (dependent variables) to the independent variables; method of selection, organizational configuration, certification of the state comptroller, and length of tenure of the state comptroller. In summary, the research produced the following findings: Method of selection was found to be a factor in satisfaction of the needs of the financial community, an external constituency of the state comptroller's agency. Generally, more political, higher profile comptrollers, those appointed by and serving at the pleasure of the governor and those who are directly elected, were found to be more effective than lower profile, less political comptrollers appointed at lower levels of government. Method of selection was not found to be a factor in satisfaction of the needs of other, internal constituencies. Organizational configuration of the comptroller’s agency in the context of the larger government was not found to be a factor in effectiveness. Professional certification of the state comptroller was not found to be a factor in effectiveness of the state comptroller. Elected comptrollers, who are less likely to be professionally certified than comptrollers selected by other methods, are effective. Tenure in office on the part of the state comptroller is not a factor in effectiveness of the comptroller’s agency.

In the United States of America today, there are concerns regarding the appropriate functioning of the police service and a lack of effective police accountability. African Americans have often been victims of unprofessional police conduct; however, their views have rarely been found adequately represented in the literature on the subject. The purpose of this case study was to fill this identified gap in the academic literature. A conceptual framework composed of the afrocentric, environmental contingency, and conflict theories was used to guide and inform this inquiry. The main research question focused on discovering which form of police oversight is seen as the most trusted, respected, and fair method of ensuring police accountability from an African American perspective in a mid-western U.S. city. Data were collected through review of pertinent documents, and through interviews and observation of 8 purposefully selected members of the African American community in the city. All data were inductively coded and then subjected to thematic analysis.The key finding of this study revealed that the most trusted, respected, and fair method of ensuring police accountability within the local African American community is a process that is not controlled only by the police. Participants consistently noted that it was their belief that an outside person, board, committee, or agency should evaluate cases of unprofessional police conduct, when appropriate. The findings of this study resulted in recommendations to the police leadership that may provide increased understanding, give a voice to this community, assist in devising good public policy, and benefit all citizens of the region.

Despite a long-running debate about the existence and nature of the nonprofit sector, scholars rarely make clear how organizations constitute the sector, nor do they describe how this sector evolves. Scholars have typically focused on one of two conceptions about the sector -- either as a unitary sector or as individual sub-areas of a nonprofit sector. The following questions emerge: is there a nonprofit sector as has been asserted by some scholars? If there is a nonprofit sector, how does the nonprofit sector evolve? What is problematic about this inquiry is that there exist various distinctive types of nonprofit organizations that cannot easily be integrated into a notion of a unitary nonprofit sector. On the other hand, they cannot be treated as being completely different from others. So, how can this diversity of nonprofit organizations be understood? And how can the organizational dynamics of nonprofit organizations be explained? Does a "broad," unitary nonprofit sector have its own dynamics of organizational change regardless of sub-components within the sector? Or do sub-population nonprofit organizations have their unique dynamics regardless of the existence of a "broad" nonprofit sector? If so, are there distinguishable effects of a "broad" nonprofit sector on the evolution of sub-populations of nonprofits? These questions are not only related to nonprofit studies, but also to the main questions of the population ecology perspective. Cooperative and competitive interrelationships are central to organization theory. Organizational ecology, and density-dependence theory in particular, investigates how large-scale mutualistic and competitive processes affect the entry, or birth, -of new organizations, and thus large-scale organizational evolution. To date, existing ecological research has focused on populations of organizations that are relatively homogeneous with respect to their organizational form – often defined through salient product markets. However, some organizational forms are complex, thus resulting in heterogeneous populations, as illustrated by the nonprofit sector. The nonprofit sector holds a common cognitive base that has been accepted by the public but operates in diverse arenas with different strategies and organizational forms. From a theoretical perspective that uses population ecology and density dependence theory, the present study investigates what implications such heterogeneity has on the mutualistic and competitive relationships within a population, and how this affects the predictions of nonprofit organization entry. The identity approach to organizational forms is used as a basis for conceptualizing complex forms as systems of hierarchically nested sub-forms. Furthermore, the issue of hierarchical form complexity is extended by combining the differences of geographical location that have been studied by ecologists. Hypotheses are derived regarding density-dependent entry in heterogeneous populations characterized by complex organizational forms. The hypotheses are tested with comprehensive data on nonprofit organizations in Florida counties from 1994 to 2007, including ten sub-forms and eight geographical boundaries of sub-forms. This study anticipates that the systemic hierarchical structures in terms of both form and location of populations have impacts on the entry of sub-forms. The key findings of the study can be summarized as follows. First, the systemic structure of the underlying complex form has clear implications for the operation of the processes of density-dependent legitimation and competition. The different units and levels have clear communal interdependencies and exert mutualistic and competitive forces on one another. Second, legitimation tends to operate on a broader scale than competition. Within the simple systemic structure with the sub-populations nested directly under the main population, virtually all ecological competition is contained at the sub-population level. However, the main population has a much stronger legitimizing effect on sub-population entry than the individual sub-populations themselves. Third, the regional density variables show no effects in most models, unlike a number of earlier studies based on the empirical tests of industrial organizations in the geographical context. This may be interpreted as meaning that nonprofit organizations are strongly rooted in the local community. The present study contributes to organization theory by shedding additional light on the mechanisms creating organizational diversity, how such diversity is structured, and what implications such diversity has on the large-scale mutualistic and competitive interdependencies between organizations. Density dependence theory is extended by proposing how legitimation and competition operate in settings with complex organizational forms and underlying multilevel systems of forms. For a nonprofit sector study, most importantly, this study provides a significant clue about understanding the existence and nature of the nonprofit sector. Unlike the dominating two conceptions about the sector -- either as a unitary sector or as individual sub-areas of the nonprofit sector without considering other nonprofit dimensions, this study shows that a nonprofit sector is in fact a heterogeneous population with significant constituent nonprofit sub-populations. This study also has implications for nonprofit managerial practice. For potential entrepreneurs' decisions to create organizations, it is possible to infer which kinds of external settings are most favorable for entrepreneurial activity, and where the entry of new nonprofit organizations is at its toughest. For nonprofit managers, it may be advantageous for individual organizations to follow and even replicate existing organizational forms that have attained considerable amounts of legitimation. The study also has important implications for nonprofit managers who seek to expand service boundaries of a nonprofit organization. / A Dissertation submitted to the Askew School of Public Administration and Policy in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Degree Awarded: Summer Semester 2010. / Date of Defense: June 17, 2010. / Nonprofit Organizations, Organizational Theory, Population Ecology, Density Dependence Theory / Includes bibliographical references. / Ralph S. Brower, Professor Directing Dissertation; John Mayo, University Representative; W. Earle Klay, Committee Member; Kaifeng Yang, Committee Member.

Thesis (M.P.A.)--Kutztown University of Pennsylvania, 2001. / Source: Masters Abstracts International, Volume: 45-06, page: 2933. Typescript. Abstract precedes thesis as preliminary leaves. Includes bibliographical references (leaves 81-83).

Thesis (M.A.)--University of Hong Kong, 1974. / Typescript.

Thesis (M.A.)--University of Hong Kong, 1978.

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