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Selikane, Mapaseka. "Evaluation of the 1988 user-fee policy in Lesotho." Master's thesis, University of Cape Town, 2001. http://hdl.handle.net/11427/9348.
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Bibliography: leaves 99-104.<br>This report provides a comprehensive evaluation of the factors underlying the evolution, design and implementation of the 1988 fee policy in Lesotho. The chief aim of the study was to conduct a critical appraisal of this policy, focusing on the key factors that might have constrained or facilitated the process. The performance of the policy was assessed in terms of financial sustainability in the health sector as well as promotion of equitable access for economically marginalized groups.
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Wang, Ming-Sen. "Three Essays on Economics of Public Policy." Diss., The University of Arizona, 2014. http://hdl.handle.net/10150/321492.
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My dissertation focuses on developing and applying program evaluation techniques to better understanding how public policies affect low-income households and social mobility. In general, my research attempts to address three questions regarding the effect of public policies: (1) What is the long-term effect of the policy? (2) Does the policy foster social mobility? (3) Is there an unintended consequence of the policy? In my view, equality of opportunity is one of the pillars of a free society. I favor the idea that poor children have equal opportunities for success. Since children from low-income families grow up in a relatively disadvantaged environment, public policies that redistribute resources to poor children can foster social mobility. However, as well-documented in the literature, redistribution policies lead to a change in incentives. In some cases, these unintended consequences offset the ``benevolence" of the policy. As a labor economist interested in policy analysis, I focus on evaluating a policy from these three perspectives. In the three essays in my dissertation, I answer the policy-relevant questions using different econometric approaches. When an exogenous policy change is available, a simple econometric model with few assumptions can provide credible answers. If we do not have a natural experiment in the context of the question, I model the selection process so that we can still learn from the data. In the first essay, I investigate whether exam preparatory programs in Taiwan are effective. I set up a Bayesian selection model that formalizes the selection process and explicitly takes into account parameter heterogeneity. In the second essay, I study the effect of the expansions of Medicaid in 1990 on childhood obesity. The Omnibus Budget Reconciliation Act 1990 expanded eligibility to children who were born after September 30, 1983 from families below the poverty line. I employ the birth date discontinuity to study the policy effect. In the third essay, I develop a new test based on the empirical distribution functions of the compliers in the Local Average Treatment Effect (LATE) model. This method tests the validity of the LATE model, which is a common empirical strategy when endogeneity is an issue. In my first essay, I estimate the impact of attending exam preparatory programs, in particular “cram schools,” on students’ academic performance. These programs are the product of market system and the Joint Entrance Exam System, which has been in place for decades in Taiwan. I measure the outcome by admission to a public high school and an “elite” high school. Focusing on the problem that students are not randomly assigned to “cram schools,” I approach the issue using propensity score matching and a Bayesian simultaneous-equations model. Using data from a survey of Taiwanese junior high school students in the Taiwan Youth Project, I find evidence that there is an insignificantly negative sorting into exam preparatory programs and attending an exam preparatory program improves a student’s high school placement. Both approaches indicate similar positive treatment effects. The second essay studies the effect of Medicaid expansions on childhood obesity and finds robust evidence of ex-ante moral hazard induced by public insurance. I establish this result by estimating two reduced-form models and a structural model. My reduced-form identification strategy exploits eligibility discontinuity created by the Omnibus Budget Reconciliation Act 1990, which extended Medicaid eligibility to children from families below the federal poverty threshold and born after October 1983. Drawing on the MEPS, I find offering low-income children public insurance leads to an approximately 10-percentage-point increase in the chances of obesity. Combining the MEPS and the SIPP, I am able to investigate the effects of insurance take-up. I estimate a fuzzy regression discontinuity design using Angrist-Krueger two-sample IV estimator (Angrist and Krueger 1992). The results suggest that early insurance take-up induced by the expansions of Medicaid leads to a roughly 5-percentage-point increase in chances of obesity. I also develop and estimate a two-period structural model that quantifies moral hazard, net-wealth effect, and risk preferences. I use the estimates to study the relative importance of income effect and moral hazard in the childhood obesity problem. The estimates of the choice model suggest that net-wealth effect is a statistically significant avenue to the observed policy effect. In the third essay, I develop a method to test the validity of the Local Average Treatment Effect (LATE) model. The LATE model is widely applied to evaluating policies when randomized experiments are impossible. The model relies on two critical assumptions: (1) the existence of a randomly assigned instrument that affects the outcome variable only through the treatment; and (2) the instrument only affects the treatment selection in one direction. The basis for the test is an estimator for the distribution function of the compliers. If the CDFs decrease more than the derived bound, then we reject the assumption of the exclusion restriction. If the CDFs are not completely non-decreasing, then either one of the assumptions fail to hold. To show the applicability, I apply the test to three datasets.
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Fleming, Brian James. "The social gradient in health : trends in C20th ideas, Australian Health Policy 1970-1998, and a health equity policy evaluation of Australian aged care planning /." Title page, abstract and table of contents only, 2003. http://web4.library.adelaide.edu.au/theses/09PH/09phf5971.pdf.
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Salmon, Allison Maree Public Health & Community Medicine Faculty of Medicine UNSW. "Policy and public health: an evaluation of the Sydney medically supervised injecting centre." Publisher:University of New South Wales. Public Health & Community Medicine, 2008. http://handle.unsw.edu.au/1959.4/43801.
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While supervised injecting facilities (SIF) can be found world-wide they remain politically sensitive and controversial public health policy initiatives and several important questions pertaining to SIFs remain unanswered. What type of evidence is necessary to validate controversial public health policy initiatives such as SIFs? How much evidence is enough to support public health policy initiatives to address the health of marginalised groups in our society such as injecting drug users? This thesis presents the results of a number of studies designed to evaluate the success of the Sydney Medically Supervised Injecting Centre (MSIC) against its stated objectives. Firstly, a background to Supervised Injecting Facilities (SIFs) generally and the Sydney MSIC specifically is provided, as well as a summary of evidence of their effectiveness to date. Secondly, a descriptive study is presented which is designed to assess the success of the MSIC in attracting a target population of high-risk IDUs and its success in providing a gateway to treatment. Thirdly, evidence of community support for the MSIC is presented, as are perceptions of drug-related public amenity prior to and following Sydney MSIC establishment, based on repeat cross-sectional random surveys. Presented next are the findings of an ecological study investigating the success of the MSIC against its stated objective of decreasing overdose deaths using three different indicators. The final empirical chapter presents a prospective observational study which investigates the potential impact of MSIC utilisation on levels of public injecting drug use among a client cohort. The findings of these studies are then integrated with existing evidence relating to the effectiveness of SIFs and critically reviewed according to the hierarchy of evidence framework. Finally, a way forward in assessing the effectiveness of SIFs, and other controversial public health initiatives, is presented in the form of an alternative public health-focussed framework.
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Malins, Gillian Leigh. "Mental health consumers' experiences of becoming evaluation researchers." Access electronically, 2005. http://www.library.uow.edu.au/adt-NWU/public/adt-NWU20060307.113753/index.html.
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Sherry, Tisamarie Bose. "Maternal Health and Child Development Programs in the United States and Rwanda: An Evaluation of Policies to Improve Quality and Efficiency." Thesis, Harvard University, 2012. http://dissertations.umi.com/gsas.harvard:10657.
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This dissertation evaluates national programs in the United States and Rwanda that aim to strengthen maternal care and promote healthy child development, which remain significantly policy challenges globally. Chapter one analyzes the impact of Rwanda’s national pay-for-performance (P4P) program on rewarded maternal and child health services, multitasking and health outcomes. In a difference-in-differences analysis using the Rwanda Demographic and Health Surveys, we find that P4P significantly increased the output of several rewarded maternal health services, but had no significant impact on other rewarded services or health outcomes. There was little evidence of multitasking. We also find mixed effects of P4P by baseline facility quality. Our results highlight the opportunities and challenges in implementing P4P in resource-limited settings. Chapters two and three examine Head Start, the largest federally funded child development program in the US. In chapter two, using experimental data from the Head Start Impact Study (HSIS) I compare the effects of Head Start on child development relative to two distinct groups: children who received home care, and children who attended other non-Head Start centers. Relative to home care, I find that Head Start achieves larger gains across a range of developmental outcomes; relative to other centers, Head Start’s impacts are smaller and restricted to improved behavior and access to health care. Compared to either group, gains from Head Start largely dissipate within one year of leaving the program. These findings suggest that Head Start enhances child development in the short-term, particularly in comparison to home care – but also raise questions about longer-term impacts. Chapter three examines efficiency and equity trade-offs of targeting strategies that seek to increase Head Start’s average impact by prioritizing enrollment of children with larger expected treatment effects. I identify child and family characteristics that predict variations in Head Start’s impacts in the HSIS data, construct targeting strategies based on these characteristics, and simulate their effects on cumulative program impacts and equity measures. I find that prioritizing enrollment of 4 year-olds otherwise likely to receive home care achieves the largest efficiency gains, but increases racial disparities in access to Head Start. Further prioritizing the enrollment of children from the most disadvantaged households, however, can eliminate these disparities while maintaining efficiency gains.
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Garabedian, Laura Faden. "Quasi-Experimental Health Policy Research: Evaluation of Universal Health Insurance and Methods for Comparative Effectiveness Research." Thesis, Harvard University, 2013. http://dissertations.umi.com/gsas.harvard:10764.
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This dissertation consists of two empirical papers and one methods paper. The first two papers use quasi-experimental methods to evaluate the impact of universal health insurance reform in Massachusetts (MA) and Thailand and the third paper evaluates the validity of a quasi-experimental method used in comparative effectiveness research (CER).
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Jin, Yue. "Ending Tobacco Sales in Pharmacies: A Comprehensive Evaluation on Tobacco-free Pharmacy Laws." The Ohio State University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=osu1437563357.
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Craig, Jean E. "An Evaluation of the Economic Impact of P.L., 101-336, Americans with Disabilities Act on a Community Hospital." TopSCHOLAR®, 1993. http://digitalcommons.wku.edu/theses/1679.
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Public Law 131-336, Americans With Disabilities Act (ADA), is comprehensive legislation created with the intention of integrating the disable into the work place and every segment of society. Forty-three million Americans are disabled. Of these, twenty-three million seek employment, but because of discrimination are unable to find work. The law provides requirements for access to public accommodations. All disabled Americans deserve the opportunity to enjoy the same public services as the non-disabled.
Businesses are now required to provide reasonable accommodations to a disabled employee if these accommodations will allow the employee to perform the essential functions of the job. Businesses are also required to make necessary renovations to their facilities to allow the disabled to move freely about and enjoy the services and amenities of the facility.
This researcher attempts to compile the costs of complying with the ADA in one hospital. The analysis is limited to one facility. However, the findings may be beneficial to other facilities because severe civil penalties can be levied on facilities which do not comply.
The study involved surveying a healthcare facility using points from Title I of the ADA determined by the researcher to be necessary for compliance. Title III compliance was accomplished using a facility survey from developed by the American Hospital Association.
The researcher complied total expenditures by The Medical Center at Bowling Green, Bowling Green, Kentucky, to comply with Titles I and III of the ADA as well as projected costs associated with recommendations to resolve deficiencies.
The findings support the hypothesis that practical approaches and inexpensive solutions are readily available so facilitates can fully comply with the intent of the law and avoid undue hardship.
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Pérez, Durán Ixchel. "Accountability for public policies the case of health policy in Spain." Doctoral thesis, Universitat Pompeu Fabra, 2013. http://hdl.handle.net/10803/130818.
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This research is a contribution to the analysis, measurement and explanation of accountability for public policies. Firstly, I develop a proposal to analyze and measure accountability for public policies. This proposal is innovative since it provides an analytical framework that can be used to measure and compare levels of accountability in different kinds of policies (e.g., health, education, pensions, etc.) or in different contexts (from countries or regions to complex multi-layered authority structures). Secondly, I test the validity of my proposal with an empirical application centered in the health policy in Spain, whose decentralized design allows analyzing the differences in levels of accountability of health policies in each of the 17 autonomous communities. Finally, I analyze the causal conditions that can -or can not- lead to the accountability of this public policy.<br>Esta investigación es una contribución al análisis, la medición y la explicación de la rendición de cuentas de las políticas públicas. En primer lugar, desarrollo una propuesta para analizar y medir la rendición de cuentas de las políticas públicas. Esta propuesta es innovadora, ya que proporciona un marco analítico que puede ser utilizado para medir y comparar niveles de rendición de cuentas en diferentes áreas de políticas (por ejemplo, salud, educación, pensiones) y en diferentes contextos (por ejemplo, entre distintos países, regiones o gobiernos multinivel). En segundo lugar, pongo a prueba la validez de mi propuesta con una aplicación empírica centrada en la política de salud en España, cuyo diseño descentralizado permite analizar las diferencias en los niveles de rendición de cuentas de esta política en cada una de las diecisiete comunidades autónomas. Finalmente, analizo las variables que pueden favorecer o dificultar la rendición de cuentas de esta política pública.
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Morain, Stephanie. "Contested Boundaries: Evaluating Institutional and Government Authority in Academia and Public Health." Thesis, Harvard University, 2014. http://dissertations.umi.com/gsas.harvard:11264.
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This dissertation explores tensions between individual freedom and institutional authority. Chapter one examines public perceptions of the legitimacy of "new frontier" public health measures. I present results from a national survey of 1,817 adults concerning the acceptability of public health interventions for noncommunicable diseases. We found that support for these interventions is high overall; strongly associated with race and political orientation; and tied to perceptions of democratic representation in policy making. There was much support for strategies that enable people to exercise healthful choices, but considerably less for more coercive measures. These findings suggest that the least coercive path will be the smoothest. Additionally, the findings underscore the need for policy makers to involve the public in decision making, understand the public's values, and communicate how policy decisions reflect this understanding.
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DeGroff, Amy S. "New Public Management and Governance Collide: Federal-Level Performance Measurement in Networked Public Management Networks." Atlanta, Ga. : Georgia Institute of Technology, 2009. http://hdl.handle.net/1853/29654.
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Thesis (Ph.D)--Public Policy, Georgia Institute of Technology, 2009.<br>Committee Chair: Theodore H. Poister, Ph.D.; Committee Member: Gordon Kingsley, Ph.D.; Committee Member: John Thomas, Ph.D.; Committee Member: Judith Ottoson, Ph.D.; Committee Member: Patricia Reeves, Ph.D. Part of the SMARTech Electronic Thesis and Dissertation Collection.
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Sanders, Danna Lane. "An Evaluation of the Utilization and Outcomes of a Georgia County Board of Health Innovative Worksite Wellness Policy." Digital Archive @ GSU, 2009. http://digitalarchive.gsu.edu/iph_theses/64.
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Introduction: Adult obesity is a significant public health problem, increasing chronic disease and resulting in health and economic implications. The worksite environment provides a setting for comprehensive Worksite Health Promotion programs that can benefit employees and employers. However, the literature identifies barriers to implementation of WHP programs and achievement of positive outcomes. The purpose of this study was to determine if a DeKalb County Board of Health Employee Wellness Policy that provides work breaks during the workday for employees to engage in wellness activities has resulted in actual use of the break and employee perceived benefits. The study also examined barriers to use of the wellness break. Methods: In collaboration with the DeKalb County Board of Health, a cross-sectional study of 187 employees across eight locations was conducted. The survey instrument included both quantitative and qualitative questions and was administered electronically or in person via group administration. Results: Of survey respondents, 74% knew about the Employee Wellness Policy, 57% understood policy guidelines, and 41% had ever used wellness breaks. Respondents most often reported using wellness breaks for physical activity, most often for walking/jogging. A majority of employees using wellness breaks reported positive outcomes including: increased physical activity (64.4%), weight loss (65.2%), increased productivity (79.5%), improved work relationships (86%), increased work morale (64.4%), and increased overall positive outlook (69.9%). Barriers to utilization included: lack of time, lack of knowledge, lack of encouragement from management, and clinical setting. Management employees were significantly more likely to know about the policy and understand policy guidelines compared to non-management employees. Clinical employees were significantly less likely to ever use wellness breaks and less likely to feel their manager supports the policy. Conclusion: Sampled employees participating in wellness breaks perceive health and work-related benefits; however barriers have prevented some employees from utilizing the breaks. Quantitative and qualitative data may inform wellness policy changes for improved utilization and outcomes. Findings related to self-reported employee outcomes provide some support for a discretionary paid work break policy in the workplace.
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Zhao, Chen. "Evaluating Health Policy Effect with Generalized Linear Model and Generalized Estimating Equation Model." The Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu1586377218891854.
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Gisler, Paula. "COMPETITIVE FOOD POLICY IMPLEMENTATION IN KENTUCKY SCHOOLS." UKnowledge, 2016. http://uknowledge.uky.edu/nursing_etds/20.
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This study was designed to explore the literature on competitive food policy implementation (CFPI); examines demographic and school factors associated with CFPI; and explores the experiences of school leaders and staff in CFPI using a proposed theoretical framework to guide the research. Competitive foods are those sold in vending machines, a la carte settings, fundraisers, class parties and other venues which compete with foods offered through the national school lunch and breakfast programs. Competitive foods have traditionally been of low nutritional value and high energy density. CFPI may be effective in reducing student calorie intake and BMI. However, evaluation of competitive food policy effectiveness is difficult due to variability in policy implementation. A theoretical framework is needed to guide research on CFPI.
This research was a mixed methods study including a review of the literature, quantitative secondary analysis, and a qualitative content analysis of transcripts from semi-structured interviews with school personnel to understand their experience with CFPI. First, a systematic review of the research literature on CFPI was conducted. Demographic and school factors, policy features, and school and parent/community-level factors that impact CFPI were identified. Second, the association of multiple demographic and school factors with CFPI scores was examined. CFPI scale (overall) and sub-scales (“inside” and “outside” school) were developed and validated to evaluate CFPI effectiveness in Kentucky middle and high schools (N=640, grades 5-12). The scales were based on responses to 8 questions on competitive food practices from a 2011 School Tobacco and Wellness Policy biannual survey conducted by the University Of Kentucky College Of Nursing Tobacco Policy Research Program. Student BMI tracking and presence of a written wellness policy predicted higher scores on the overall CFPI scale (BMI OR=2.06, p=0.001; Wellness OR=1.74, p=0.02), inside subscale scores (BMI OR=2.46, p<0.0001; Wellness OR=1.58, p=0.05), and outside subscale scores (BMI OR=2.27, p=0.03; Wellness OR=1.54, p=0.0005). Greater county-level adult obesity rates predicted lower overall CFPI scores (OR=0.93, p=0.02). Private school status predicted lower scores on inside CFPI subscale scores (OR=0.47, p=0.004). Third, semi-structured interviews were conducted with 23 school personnel to explore CFPI. Interviews were recorded, transcribed and content analysis was conducted. Kentucky schools were stratified into four groups based on school level (middle or high) and CFPI scores (high or low). Sixteen schools were randomly selected for each of the four groups. A total of eight schools, two from each group, agreed to participate. The interview guide was based on a proposed CFPI framework based on implementation science, educational and organizational theory research. Six key themes emerged: internal/external forces enabling CFPI; internal and external obstacles to CFPI; key organizational values; organization value of CFPI; methods that organizations use to communicate organizational values; and CFPI policies and procedures. Findings were discussed in the context of the proposed theoretical framework. Implications for policy, practice and future research are presented.
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Sequeira, Shwetha Sophia. "Evaluation the quality of sexually transmitted infection care: a comparison of five clinical settings at an urban safety net hospital." Thesis, Boston University, 2013. https://hdl.handle.net/2144/21252.
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Thesis (M.S.H.P.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.<br>IMPORTANCE: With greater access to health care through health care reform it is important to know if quality of care for similar complaints differs across clinical settings.
OBJECTIVE: Develop and pilot a chart review instrument to measure quality of care for patients presenting with urethritis and vaginitis.
METHODS: List of sexually transmitted infection (STI) quality of care measures was reviewed by a panel of five STI experts representing Emergency Department (ED), Obstetrics/Gynecology (Ob/Gyn), Family Medicine (FM), Primary Care (PC) and Infectious Disease. Panel members grouped each measure into “standard” or “exceeds standard of care” in evaluation and management of male patients with penile discharge/dysuria or female patients with vaginal discharge. The chart review instrument was piloted on 50 charts per gender from the STI Clinic and matched charts, by patient presenting complaint, age, gender, and visit date, from PC, FM, ED, and Ob/Gyn (for vaginal discharge) in the same large safety-net hospital in Massachusetts.
RESULTS: Twenty-four and 34 final measures in male and female patients, respectively, were selected on plurality of expert panel member’s categorization into “standard of care”. Measures were grouped into 7 clinical domains: history, examination, laboratory testing, additional screening, assessment, treatment, and counseling. Performance on the 7 domains ranged from 3.16-4.36 on male patients and 3.17-4.40 on female patients, with the highest scores in the STI Clinic. However, each clinical setting had particular documentation strengths and weaknesses: STI Clinic scored higher on laboratory testing, additional screening, and counseling, but scored lower on examination and assessment; ED scored higher on examination and treatment; PC and FM scored higher on laboratory testing for male patients and on examination and treatment for female patients; Ob/Gyn scored higher on treatment. All sites other than the STI Clinic scored poorly on additional screening and counseling.
CONCLUSIONS: An instrument to discern standard of care and identify strengths and weaknesses in specific domains of clinical documentation for patients presenting with STI complaints can be rapidly developed and implemented to evaluate quality of care across care settings. Further research is needed on whether these findings can be integrated into site-specific quality improvement processes and linked to cost analyses.<br>2031-01-01
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Oliver, Kathryn Ann. "Evaluating power, influence and evidence-use in public health policy-making : a social network analysis." Thesis, University of Manchester, 2013. https://www.research.manchester.ac.uk/portal/en/theses/evaluating-power-influence-and-evidenceuse-in-public-health-policymaking-a-social-network-analysis(0a47c659-cbf8-49ce-9ae3-3515369590ab).html.
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Introduction: Persistent health inequalities are the focus for much public health policy activity. Understanding the policy response to public health problems, the role of evidence, and the roles and strategies of different actors may help explain this persistence. Research suggests that policy actors often access knowledge through interpersonal relations, but current perspectives in the literature do not analyse relational aspects of finding evidence and influencing policy. Identifying powerful and influential actors (in terms of personal characteristics, strategies, and network properties) offers a method of exploring the policy process and evidence use. Methods: Network data were gathered from a public health policy community in a large urban area in the UK (n = 152, response rate 80%), collecting relational data on perceived power, influence, and sources of evidence about public health policy. Hubs and Authorities analyses were used to identify powerful and influential actors, to test whether powerful and influential actors were also sources of information; and betweenness and Gould-Fernandez brokerage were used to explore the importance of structural position in policy networks. These data were analysed in conjunction with qualitative data from semi-structured interviews (n = 24) carried out with a purposive subsample of network actors. Characteristics of powerful and influential actors, the use of evidence in the policy process, and roles and strategies used to influence policy were analysed using a framework approach, and combined with network data. Results: The most influential actors were mid-level managers in the NHS and local authorities, and to a lesser extent, public health professionals. These actors occupied advantageous positions within the networks, and used strategies (ranging from providing policy content, to finding evidence, to presenting policy options to decision-makers) to influence the policy process. Powerful actors were also sources of information for one another, but providing information did not predict power. Experts, academics and professionals in public health were represented in the networks, but were usually more peripheral and played fewer roles in the policy process. This study presents empirical evidence to support the suggestion that recognition of network structure assists individuals to be influential, and proposes a framework to categorise their activities. Conclusions: In order to influence policy, actors need good relationships with other influential actors, and the skills to exploit these relationships. The relational approach is useful for both identifying powerful and influential people (potential evidence-users) and for exploring how evidence and information reaches them. Identifying powerful and influential actors and describing their strategies for influencing policy provides a new focus for researchers in evidence-based policy, and for those wishing to influence policy. For academics and researchers, this study demonstrates the importance of directly creating ties with decision-makers
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Coelho, Thiago. "Citizens policing the police an evaluation of citizens recording police officer and wiretapping laws." Honors in the Major Thesis, University of Central Florida, 2013. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/833.
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The focus of this thesis is to explore the legality, the issues, and the remedy to a controversial statute in the State of Illinois. This thesis will explain how the First Amendment relates to the Illinois statute and its desire of a citizen is right to report information that is not being granted. Moreover, this paper will further go into a recent legislative bill to amend the Illinois statute, its failure, the media surrounding the issue, and the consequences of amending or not amending the statute. It will further review state law in regard to citizens recording police officers, and explain how some states deal with the statute.<br>B.S.<br>Bachelors<br>Health and Public Affairs<br>Legal Studies
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Stalling, Veda. "The Phenomenological Evaluation of Social Worker Competencies in Patient-Centered Medical Homes." ScholarWorks, 2016. http://scholarworks.waldenu.edu/dissertations/1871.
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The Patient-Centered Medical Home (PCMH) is an innovative, team-based health care model that was applied during the implementation of the Affordable Care Act (ACA). However, the competencies for PCMH health care social worker team members are not identified within this model. Thus, the purpose of this phenomenological study focused on identifying the core competencies that will enable social workers to perform competently in PCMHs. This study also explored the roles and training needs as related to improving the competence of social workers. Sandberg’s and Parry’s conceptualization of the competency model was used as the theoretical framework. Data were acquired through interviews with 10 PCMH social workers. These data were then inductively coded and analyzed using a modified Moustakas method. Key findings indicated that these social workers believed that improvements in competencies may include training and knowledge with mental health and physical health knowledge which consist of diagnoses, interventions, medications, symptoms, and terminology. It was also noted that knowledge of evidence-based practices for mental health interventions and patient-centered, team-based principles were essential to ACA policy implementation. The positive social change implications of this study include recommendations to health care leadership, educational institutions, and other PCMH providers to develop competency-based training for social workers. Recommendations are also put forth to adapt social work curriculum to ensure the effective implementation of the principles of the ACA policy and to improve social work practice in PCMH health care settings.
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Karan, Anup. "Changing pattern of household expenditure on health and the role of public health insurance schemes for the poor in India : case of Rashtriya Swasthya Bima Yojana." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:0ad453e4-8974-48ad-8475-337e7d93d5b0.
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<b>Background</b>: In order to protect the poor from health shocks, the Government of India launched Rashtriya Swasthya Bima Yojna (RSBY) in 2008. The objectives of this study are: a) to assess the changes in the financial burden of health care on the poor population; b) to estimate the effects of RSBY in reducing the financial burden on the poor; and c) to examine the impact of RSBY on the labour supply of the poor. <b>Methods</b>: The study is based on data from the National Sample Survey Organisation (NSSO). The sample size is between 100-125 thousand households at the all-India level. The study uses pooled cross-section regression analysis to assess the changing pattern of out-of-pocket (OOP) payments on healthcare. The impact of RSBY on financial risk protection and labour force participation rate in India were estimated using the difference-in-differences (DID) method. <b>Findings</b>: My thesis consists of three papers. The findings in the first paper, changing pattern of out-of-pocket payments, reflect that the poorest 20% of households, compared to the richest 20%, realised a slower increase in out-of-pocket as a share of the household’s total expenditure (-0.5%) and catastrophic payments (-2%) during the period of 2000-2012. However, during the same period, Scheduled caste/tribe and Muslim households reported an increased burden of out-of-pocket. The second paper finds reduction in the probability of incurring ‘any inpatient expenditure’ and ‘catastrophic inpatient expenditure’ after RSBY intervention but marginal increase in the ‘per person monthly inpatient expenditure’ and insignificant change in ‘inpatient expenditure as a share of households’ total expenditure’. The effects of the scheme on the total out-of-pocket payment are negligible and non-drug expenditure reflected significant increase. The third paper finds that women’s labour supply increased (3% per annum) but the elderly labour supply declined (1.5%). Further, men switched from self-employment to casual work while women moved to wage-paid regular and casual jobs at the cost of being self-employed. <b>Discussion and conclusion</b>: The poor and other less advantaged population groups realised an increasing OOP burden mainly on account of two factors: i) outpatient care is not covered under RSBY; and ii) the benefit package under the scheme is very modest. Women’s labour supply increased and the elderly labour supply declined in favour of leisure because of possible improvements in health. However, the overall labour supply did not change. The Indian government needs to consider broadening the benefit package and including outpatient coverage under RSBY.
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Taylor, Audrey Lynn. "Evaluation of an Elementary School Wellness Concept in Rural East Tennessee." Digital Commons @ East Tennessee State University, 2007. https://dc.etsu.edu/etd/2128.
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Parents of elementary school children in the small, rural area of Unicoi County, TN were surveyed to determine their attitudes toward health, nutrition, and Unicoi County Schools' Wellness Policy. Elementary school classrooms were randomly chosen to receive surveys for the children's parents to return by mail. Data were compiled and analyzed using SPSS software. Over 99% of parents stated that nutrition education in schools was important, and 96% stated schools played an important role in their child's health. The assessment provided meaningful data and laid groundwork for future nutrition education programs. The research showed rural, lower-income parents are supportive of positive nutritional changes in schools.
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Linde, Anders. "Evaluative study of Tanzania’s public policies : Special focus on Education, Health and the Environment." Thesis, Linnéuniversitetet, Institutionen för samhällsstudier (SS), 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-38379.
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Gazy, Michael G. "What is a City but the People?: An Evaluative Study of the Development and Implementation of a 10-Year Plan to End Chronic Homelessness in Macon, Georgia." Digital Archive @ GSU, 2010. http://digitalarchive.gsu.edu/iph_theses/174.
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Introduction:
Contemporary circumstances have increased the occurrence and risk of homelessness for millions of Americans. The Macon Coalition to End Homelessness (a group of homeless service providers in the Macon-Bibb County) has noted the need for a comprehensive, evidenced-based plan which would more efficiently coordinate and dispense services for homeless people; with the eventual goal of preventing/mitigating the influence of factors which initiate, perpetuate, and prevent the pathways that would lead one to establish an independent life.
Aim:
The explicit purpose of this capstone project is to analyze the processes inherent in the development and implementation of a community-based intervention aimed at homeless populations: the 10-Year Plan to End Chronic Homelessness in Macon, Georgia. The development of preventive policy initiatives and the intended target of the community-based initiatives are direct public health measures.
Methods:
This evaluative study tracks the initial development, planning, writing of a community-based intervention. The study tracks the progress of the various phases of the development of the plan. It should be noted that the author of this study was also a member of the 10-Year Plan Steering Committee and the primary author of the 10-Year Plan to End Chronic Homelessness in Macon, Georgia. These dual roles allowed the author to have unrestricted access and support regarding information pertinent to these processes.
Results:
The study analyzes the steps needed in completing a successful implementation of a 10-year Plan. Additionally, this project delivers a draft of the 10-Year Plan to End Chronic Homelessness in Macon, Georgia.
Discussion:
Finally, suggestions for further steps to be taken by the MCEH for successful buy-in and establishment of a 10-Year Plan are made. This includes strict adherence to the tenets of other succesful10-Year Plans; increased community support (both financial and in terms of volunteerism/direct service) including but not limited to governmental sponsorship, community-wide awareness, and strong private-sector support; and, the development and reliance upon systems which utilize measurable objectives – of note, this would include a more accurate census mechanism. Further examination of factors such as these should result in a tailored, highly-effective preventative community-based intervention
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Biroscak, Brian J. "Use of System Dynamics Modeling to Explicate the Theory-of-Change of a Social Marketing Innovation." Scholar Commons, 2014. https://scholarcommons.usf.edu/etd/5184.
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Community coalitions are an important part of the public health milieu and thus subject to many of the same external pressures as public health organizations--including changes in required strategic orientation. Many funding agencies have shifted their funding agenda from program development to policy change. Thus, the Florida Prevention Research Center created the Community-Based Prevention Marketing for Policy Development framework to teach community coalitions how to apply social marketing to policy change. The dissertation research reported here was designed to explicate the framework's theory-of-change. The research question was: "What are the linkages and connections between CBPM inputs, activities, immediate outcomes, intermediate outcomes, and ultimate impacts?" The author implemented a case study design, with the case being a normative community coalition. The study adhered to a well-developed series of steps for system dynamics modeling.
Results from model simulations show how gains in performance depend on a community coalition's initial culture and initial efficiency, and that only the most efficient coalitions may see benefits in coalition performance from implementing Community-Based Prevention Marketing for Policy Development. Theoretical implications for social marketers--e.g., real-world example of how to work `upstream'--and system dynamics modelers--e.g., application of generic structures--are discussed. Practical implications for the framework's developers--namely, the importance of managing the early expectations of framework adopters--are discussed as well.
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Virk, Amrit Kaur. "Expanding health care services for poor populations in developing countries : exploring India's RSBY national health insurance programme for low-income groups." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:3e65305c-ba60-408a-8c0a-8957767f6596.
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Health is deemed central to a nation’s development. Accordingly, health care reform and expansion are key policy priorities in developing countries. Many such nations are now testing various methods of funding and delivering health care to local disadvantaged populations. Similarly, India launched the Rashtriya Swasthya Bima Yojana (RSBY) national health insurance programme for low-income groups in 2008. The RSBY intends preventing catastrophic health-related expenditure by improving recipients’ access to hospital-based care. This thesis is an in-depth qualitative evaluation of the RSBY in Delhi state. It examines the RSBY’s effectiveness in fulfilling its goals and meeting local health care needs. Walt and Gilson’s (1994) actors-content-process-context model informs the research design and an actor-centred “responsive” (Stake 1975) or “constructivist” approach guides data analysis. Three research questions are examined: (i). Why was a health insurance programme launched and why now? Why was this model favoured over alternate methods of service expansion? (ii). Is the RSBY delivered as intended? If not, why? (iii) How does the RSBY affect patients’ access to services? The findings are based on documentary sources, observation of implementation sites and activities and 164 semi-structured interviews with RSBY policymakers, insurers, NGOs, doctors, and patients. The results show improved access to curative and surgical care for RSBY patients. However, RSBY’s focus on hospitalisation and omission of primary and outpatient services had undesired negative effects. The lack of ambulatory facilities led RSBY patients to self-medicate or use dubious quality informal providers. By only allowing inpatient care, the RSBY also seemingly encouraged the substitution of outpatient care with costlier hospitalisations. In effect, the RSBY’s design contributed to cost increases and poor patient outcomes. While more funds and human resources were needed to improve RSBY implementation, the performance of frontline agencies could potentially improve through more stable, longer-term contracts. Similarly, modifying RSBY’s monetary incentives for doctors may lead to better service delivery by them. By evaluating the RSBY’s strong points and shortcomings, this thesis provides key lessons on strengthening policy design and health service delivery in developing countries. Thereby, it makes a broader contribution to understanding the determinants of successful policymaking.
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Little, David C. "An evaluation of strategies for production of Nile tilapia (Oreochromis Niloticus L.) fry suitable for hormonal treatment." Thesis, University of Stirling, 1989. http://hdl.handle.net/1893/2112.
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Intensive methods for the mass production of Oreochromis niloticus (Chitralada strain) seed using concrete tanks, hapas within earthen ponds and earthen ponds were investigated. On the basis of these trials, the productivity and economic performance of various production strategies for hormonally sex-reversed Oreochromis fry (MT fry) were then compared and modelled for adoption in Central and Northeast Thailand. Regular disturbance and harvesting of seed after a short period of spawning opportunity (5-10 days) was found to increase seed production in concrete spawning tanks. Exchange of female broodfish increased synchrony of breeding. A change in conditioning and spawning environment had no effect on seed yield from spawning tanks and hapas (area =12.57 m2and 40m2 respectively). Seed wet weight, seed clutch size and weight was greater in female fish spawned in tanks than hapas. Females conditioned in hapas however produced heavier seed clutches of larger absolute and relative size than tank conditioned fish. Records of tagged females indicated considerable differences in the frequency of spawning; in hapas the distribution was normal wheras in tanks it was skewed. The evidence suggests that hierarchy is important in the control of reproduction and exerts it's strongest effect in clear water, densely stocked tanks. Selective female broodfish exchange optimised seed yield per unit weight of broodfish and seed production was not improved by conditioning females for periods longer than 10 days. Male broodfish exchange did not significantly improve (P > 0.05) seed yields. Early nutrition of broodfish raised under different supplemental feeding regimes in fertilised earthen ponds had a significant effect on later spawning frequency in concrete tanks. However, this effect was confined to broodfish maintained at densities lower or higher than optimal for seed production. Broodfish stocked over a range of densities for extended periods (201 days) showed greater variability of seed production in hapa than tank production systems. This was mainly due to periods of poor water quality in hapas; when water quality was high seed production was significantly higher in hapas than tanks over a range of broodfish densities. The optimal density of broodfish for seed production was exceeded in tanks but not hapas. The relationship between seed production and broodfish density over time suggested that both stocking biomass and number have an effect on fry output. Density of broodfish showed an inverse relationship to clutch size in both tanks and hapas and synchrony of spawning in tanks. Production of swim-up fry in large earthen ponds (area=1740m2) was not significantly different (P>0.05) at 2 levels of harvest intensity. The use of small broodfish however produced double the yield of hormone treatable fry than a similar biomass of larger broodfish of the same cohort. A commercial scale incubation system was devised and evaluated in order to allow tank and hapa systems harvesting unhatched seed to be compared with the production of swim-up fry obtained from earthen ponds. Seed removed from mouthbrooding females was roughly staged and incubated in batches of similar development to give information on survival to swim-up fry. A simple incubation system was designed with a capacity for hatching >100,000 eggs/set. A mean survival of 75% of all harvested seed to swim-up fry was obtained over several trials. A trend to intensification (fry/mVday) from ponds to hapas to tanks was evident when yields of swim-up fry are compared. Productivity exceeded any in the published literature for comparable systems, largely because of the intensity of broodstock management and early and efficient harvest of seed. Broodfish productivities (fry/kg female/month) were also higher across the range of systems tested often by a factor of 1.5-3. The best strategies were selected over a range of total investment cost using dominance analysis. Economic analysis suggested that for a start-up operation in Central Thailand fry production in earthen ponds can give the best return on levels of investment of less than Baht 0.8 million. Substitution of techniques into current carp fry production operations in Northeast Thailand indicated that more intensive methods (production in tanks and hapas) are more attractive over a range of investment levels. The break-even price of MT fry after hormone treatment in nylon hapas was approximately half the cost of treatment in a recirculated water concrete tank system. The break-even price in Central Thailand was lower than the Northeast by a factor of around 1.5 but the break-even price for both areas was lower than the current price of untreated Oreochromis fry.
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Ngarari, Jane Mururi. "HIV/AIDS education in Kenya : an evaluation of policy, provision and practice in secondary schools." Thesis, University of Birmingham, 2010. http://etheses.bham.ac.uk//id/eprint/1210/.
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One of the key responses to the HIV/AIDS crisis has been the provision of School- based HIV/AIDS education, to try and improve teenagers’ ability to make wise and sensible decisions regarding their behaviours. The interventions have been premised on links between education and behaviour, the underlying assumption being that teaching young people how to protect themselves from HIV can lead to a reduction in risk behaviour and hence a reduction in HIV incidence (UNAIDS, 1997). An important part of this process has been the development of an education sector policy on HIV and AIDS, aimed at implementing and effecting, among others, the policy goal of Prevention. This study, with the use of a systems theory as a theoretical framework, examines the policy, provision and practice of HIV/AIDS education in secondary schools in Kenya with the view to informing policy and providing options for re-designing and scaling up (if necessary) the HIV/AIDS program. A methodology combining literature review, semi- structured interviews and a school survey was adopted. The school survey covered students, teachers and Head teachers; while the semi structured interviews covered policy makers. Results revealed that there are discordances between national HIV/AIDS policy rhetoric and school realities. There is a general failure of schools to implement the type of detailed HIV/AIDS policy described despite the fact that the demand is high. Although there are merits that the study did not cover a wide enough population to warrant the generalizations it makes, the research findings and recommendations that do exist from previous investigations largely confirm rather than refute these results.
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Ferrandino, Joseph A. "Integrating theory, practice and policy the technical efficiency and productivity of Florida's circuit courts." Doctoral diss., University of Central Florida, 2010. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/4599.
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In 1998, Florida voters approved Article V, Revision 7, which changed the funding mechanism of the state circuit court system from a county/state mix to state responsibility. The change was implemented as planned in the 2004/05 fiscal year. Although increased efficiency was a key goal of Revision 7, to date no published studies exist on the impacts of Revision 7 on circuit or system efficiency and/or productivity. This work analyzes Revision 7, integrating the larger debate of increasing judgeships or improving efficiency. The study is a full performance analysis of the Florida circuit courts from 1993 through 2008 that can benchmark the system's future efficiency and productivity. In that respect, top performers are identified. The study follows the evolution of court studies from their rational origins to the more recent orientation of open-natural systems. Resource dependency and institutional theory, two open-natural system frameworks, are utilized to predict that Florida's circuit courts have become more efficient over the period since the implementation of Revision 7. The efficiency outcomes are expected to be unequal across circuit sizes. Integrating a Florida debate to a larger one that transcends time and culture, productivity changes are expected to be a function of the number of judges that a circuit adds within a given year, controlling for other factors. The results of the study methodologies--data envelopment analysis, Malmquist Productivity Index, hierarchal regression analysis and analysis of covariance--reveal that only 3 of 300 DMU's in Florida are technically efficient; the mean IOTA score is .76. The Florida circuits did not improve efficiency and productivity as expected, in fact becoming significantly less efficient over time as a function of Revision 7. Small and medium-sized circuits lost efficiency, large circuits showed no change and there was a significant interaction between circuit size and Revision 7 period.; Within the system overall, productivity fell by 2.7%, most noticeably in the small and medium-sized circuits. The number of judges a circuit added explained 32.2% of the variance in total factor productivity change. The largest system productivity losses followed both Revision 7 intervention years and the addition of the most judges in a single year. Analysis of covariance revealed that productivity increased only when no judges were added to a circuit, regardless of circuit size or time period (+2.6%). The addition of a single judge reduced average productivity by 8.6%; adding two judges reduced productivity by 10.5% and adding 3 or more judges reduced productivity by 16.2%. As judges were added, productivity declined in circuits of all sizes, but the drop was more pronounced in the small and medium-sized circuits. None of the circuits showed an increase in productivity from 1993 to 2008. Revision 7 has not increased circuit court efficiency or productivity in Florida. It is recommended that efficiency and productivity analyses be included in resource allocation decisions such as adding judgeships. More data on court structures and process are needed. Efficiency and productivity measures show that the current level of circuit court judgeships is sufficient.<br>ID: 030423165; System requirements: World Wide Web browser and PDF reader.; Mode of access: World Wide Web.; Thesis (Ph.D.)--University of Central Florida, 2010.; Includes bibliographical references (p. 151-160).<br>Ph.D.<br>Doctorate<br>Health and Public Affairs<br>Public Affairs
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Lynch, Timothy Joseph, and res cand@acu edu au. "An Evaluation of School Responses to the Introduction of the Queensland 1999 Health and Physical Education (HPE) Syllabus and Policy Documents in Three Brisbane Catholic Education (BCE) Primary Schools." Australian Catholic University. School Of Education, 2005. http://dlibrary.acu.edu.au/digitaltheses/public/adt-acuvp96.04092006.
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Within Brisbane Catholic Education (BCE) the 1999 HPE syllabus was implemented between 1999 and 2001. The purpose of the study is to evaluate the implementation of the 1999 Queensland HPE syllabus in three BCE primary schools of varying enrolment numbers. The research problem is:.How developed is the implementation of the new HPE syllabus in BCE schools?. The data collection was guided by the following research questions:- How are teachers in these BCE schools implementing the HPE curriculum documents? What readily accessible resources do schools have to assist with the implementation of Health and Physical Education?. What are teachers. perceptions with regard to the HPE Key Learning Area? What are the children.s perceptions of the HPE Key Learning Area? What implementation strategies are required to optimize HPE practices in BCE schools? This study is significant for the feedback it may provide to BCE of the HPE syllabus implementation process and in informing BCE of the current status of the HPE key learning area within a sample of systemic Catholic primary schools. The findings have the potential to contribute to the BCE Strategic Renewal Framework currently occurring within BCE schools for all curriculum areas and planned for completion by the end of 2006. This research has been designed within a constructionist paradigm. An interpretivist study was conducted employing symbolic interactionism. This qualitative, interpretive study is most appropriate as meanings were constructed. The case study methodology was chosen to construct meaning through capturing the context of each school. The sites for the three case studies involved: one small sized BCE primary school (less than 200 students); one medium sized BCE primary school (200 - 400 students); and one large sized BCE primary school (over 400 students). The participants included teachers and students from the respective schools. The data gathering strategies used were; semi-structured and focus group interviews, reflective journal note taking, observations, questionnaire and document analysis. The research concluded that factors which led to the decline in Australian HPE during the 1980s and early 1990s may have contributed to impeding the implementation challenges formulated by BCE. This was evidenced within the three BCE primary schools by unequal allocation of teaching resources, equipment, facilities, HPE teachers and HPE teacher release time for sports coordination. It appears that the implementation process ceased prematurely before all schools had had sufficient time and preparation to design whole school HPE programs. Teachers lacked understandings of practical ways to implement the social justice underpinnings of the syllabus and some school principals were unaware of the necessity of employing qualified HPE specialist teachers. The research revealed that school principals play a significant role in the implementation of the 1999 HPE syllabus, a role made more imperative by the absence of BCE HPE Curriculum Officers and systemic HPE professional development. Therefore, the HPE key learning area requires further system level support and attention so that the 1999 HPE syllabus can be implemented successfully in all BCE primary schools, enabling curriculum change to occur.
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Chace, Meredith Joy. "Evaluating Intended and Unintended Consequences of Health Policy and Regulation in Vulnerable Populations." Thesis, Harvard University, 2012. http://dissertations.umi.com/gsas.harvard:10725.
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The objective of this dissertation is to evaluate whether two different types of policy interventions in the United States are associated with health service utilization and economic outcomes. Paper 1: The number of government lawsuits accusing pharmaceutical companies of off-label marketing has risen in recent years. We use Medicare and Medicaid claims data to evaluate how an off-label marketing lawsuit and its accompanying media coverage affected utilization and spending on gabapentin as well as other anticonvulsant medications. In this interrupted time series analysis of dual eligible patients with bipolar disorder, we found that the lawsuit and accompanying media coverage corresponded with a decrease in market share of gabapentin, a substitution of newer and expensive anticonvulsants, and a substantial increase in overall spending on anticonvulsants. Paper 2: Medicare Part D was a major expansion of Medicare benefits to cover pharmaceuticals. There were initial concerns about how the dually eligible population who previously had drug coverage through Medicaid would fare after transitioning to Part D plans. Using a nationally representative longitudinal panel survey of Medicare Beneficiaries that are dually eligible for Medicaid, we investigated whether differences in generosity of Medicaid drug benefits were associated with differential changes in drug utilization and out-of-pocket spending for duals after they transitioned to Part D. Our finding suggest that those who previously encountered a monthly drug cap prior to Part D implementation experienced a differentially higher increase in annual prescription drug fills compared with those who did not face a cap.
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Zhang, Wei, Long Chen, Huanhuan Wang, et al. "Economic Evaluation of Health Benefits of Mercury Emission Controls for China and the Neighboring Countries in East Asia." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/2619.
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Globally, coal-fired power plant (CFPP) is a major source of mercury. China is developing its first National Implementation Plan on Mercury Control, which priorities the control of emissions from CFPPs. While social benefits play an important role in designing environmental policies in China, the benefits associated with mercury control are not yet understood, mainly due to the scientific challenges to trace mercury's emissions-to-impacts path. This study evaluates the benefits of mercury reductions in China's CFPPs for China and its three neighboring countries in East Asia. Four policy scenarios are analyzed following the policies-to-impacts path, which links a global atmospheric model to health benefit analysis models to estimate the economic gains from avoided mercury-related adverse health outcomes under each scenario, and take into account key uncertainties in the path. Under the most stringent scenario, the benefits of mercury reduction by 2030 are projected to be $432 billion (95% CI: $166–941 billion), with the benefits for China and the neighboring countries accounting for 96% and 4% of the total benefits, respectively. Policy scenario analysis indicates that coal washing generates the greatest benefits in the near term, whereas upgrading air pollution control devices maximizes health benefits in the long term.
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Iovanna, Anthony. "Evaluating Uranium Depth Versus Socio-Economic Statistics for Residential Radon Vulnerability in Warren County, Kentucky." TopSCHOLAR®, 2004. http://digitalcommons.wku.edu/theses/529.
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Residences in Warren County, Kentucky, are characterized by high levels of residential radon, which is one of the radioactive daughter products of uranium. According to the United States Environmental Protection Agency (US EPA), radon exposure causes approximately 22,000 lung cancer deaths in the United States per year. The City of Bowling Green, in Warren County, is underlain by karst, an easily soluble limestone subsurface, which allows radon gas to travel easily through cracks and fissures. Carbonate rocks under Bowling Green are underlain by the Devonian Chattanooga Shale, a low-grade uranium ore and a potential source of radon gas. A digital map of the Chattanooga Shale was created using Arc GIS. A 1.6 km by 1.6 km (one-mile by onemile) grid for Warren County was generated, and depth data from oil wells within each grid cell were averaged to render the elevation of the top surface of the Chattanooga Shale in a digital format. A socio-economic GIS of Warren County was created using US Census Bureau and Property Value Administration data. The Chattanooga Shale and the socio-economic layers were correlated to test points that have high residential radon measurements to determine whether proximity to the shale layer or home type is the better predictor for radon risk. Once risks have been determined, management decisionmaking is simplified and resources can be targeted towards high need areas. Although this study determined that home type, i.e., size of the home and whether there is a basement present, does have a significant effect on residential radon levels, proximity to the top surface of the Chattanooga Shale does not have a significant effect in Warren County, Kentucky. Due to this lack of a geologic pattern it is recommended that radon mitigation systems be included in all new home construction and design.
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Costa, Renata Lima da. "AvaliaÃÃo das AÃÃes de SaÃde do Trabalhador e Suas RepercussÃes Para o Processo de Trabalho." Universidade Federal do CearÃ, 2013. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=14049.
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nÃo hÃ<br>A presente pesquisa tem por objeto de estudo as aÃÃes de saÃde do trabalhador, pautadas na PolÃtica Nacional de SaÃde do Trabalhador do MinistÃrio da SaÃde. Gestada inicialmente como um plano nacional, foi posta para consulta pÃblica e, posteriormente, no ano de 2004, entrou em vigor. Esta traz como proposta a reduÃÃo dos acidentes e doenÃas relacionadas ao trabalho, mediante a execuÃÃo de aÃÃes de promoÃÃo, reabilitaÃÃo e vigilÃncia na Ãrea de saÃde. Em uma visÃo ampla, o Sistema Ãnico de SaÃde (SUS) pauta- se na noÃÃo de integralidade do sujeito, percebendo-o como um ser completo e Ãnico. A dissertaÃÃo teve por objetivo avaliar as aÃÃes de saÃde do trabalhador e suas repercussÃes para o processo de trabalho dos sujeitos envolvidos (garis), por meio de investigaÃÃo realizada na Empresa Municipal de Limpeza e UrbanizaÃÃo (EMLURB), na Ãrea de abrangÃncia da Secretaria Executiva Regional (SER) IV, onde estÃo situadas as zonas geradoras de lixo (ZGL) 13, 14 e 15. No sentido de fundamentar tal estudo, foram realizadas leituras diferenciadas acerca das concepÃÃes diversas que envolvem as categorias norteadoras do estudo, como saÃde e trabalho. A pesquisa parte do pressuposto de que o sujeito à um ser integral e, desta forma, a concepÃÃo de saÃde preconizada pelo SUS deve estar evidenciada nas diversas prÃticas, em diferentes instÃncias institucionais, no sentido de facilitar a compreensÃo e prÃtica do princÃpio da integralidade proposto por esta polÃtica. Trata-se de uma pesquisa avaliativa que intencionou a escuta dos sujeitos por meio da realizaÃÃo de entrevistas abertas e aplicaÃÃo de questionÃrios fundamentais para a coleta e a anÃlise dos dados, bem como a pesquisa documental, bibliogrÃfica e observaÃÃo in loco, que viabilizaram a compreensÃo da realidade. O estudo possibilitou perceber o entendimento sobre as aÃÃes de saÃde do trabalhador praticadas em Ãmbito institucional e como este aspecto està posto no processo de estruturaÃÃo da polÃtica estudada.
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Saito, Asumi, and Asumi Saito. "The Effect of Supplemental Nutrition Assistance on Fruit and Vegetable Consumption in Arizona." Thesis, The University of Arizona, 2017. http://hdl.handle.net/10150/625343.
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The Supplemental Nutrition Assistance Program (SNAP) is the largest domestic hunger safety net program in the United States. It has been shown that SNAP increases households' purchasing power. However, only a quarter of Americans follow recommended healthy eating patterns. Hence, there is a question whether the additional income from SNAP transfers to healthier eating. This paper addresses three questions. First, what factors explain SNAP participation of low-income individuals in addition to basic income eligibility requirements? Second, does SNAP participation increase fruit and vegetable consumption? Third, what effect does the Supplemental Nutrition Assistance Program Education (SNAP-Ed) in Arizona have on fruit and vegetable consumption for low-income households? The data used in this study were drawn from two waves of the Arizona Behavioral Risk Factor Surveillance System survey. The study found people in Arizona ate fruits, on average 1.4 times per day and vegetables 1.6 times per day. Marital and household arrangement status significantly affected both SNAP participation and fruit and vegetable consumption, but effects for men and women differed. Distance from services assisting with SNAP enrollment appeared to have no negative effect on eligible respondent enrollment. People living in counties with more SNAP-Ed contractors per person below 125% of the poverty line consumed more fruits and vegetables, but the effect was only marginally significant. Future research should consider more geographically specific measures of SNAP-Ed reach.
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Johnson, Paul G. "EVALUATION OF FLUOROSCOPY RADIATION WORKER EXPOSURE AT A LARGE MEDICAL CENTER: IMPLICATIONS FOR UTILIZING GRAPHICAL FEEDBACK INFORMATION FOR IMPROVING OCCUPATIONAL SAFETY." Kent State University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=kent1523631347981258.
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Lee, Elizabeth H. "Perceptions and Evaluation of an Urban Environment for Pedestrian Friendliness: A Case Study." DigitalCommons@CalPoly, 2010. https://digitalcommons.calpoly.edu/theses/391.
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Public health is an increasingly important issue addressed from both environmental and public health sectors for the future development of urban environments. From a planning perspective, one possible solution is to increase walkability throughout the cities. Many assessment methods are being developed and administered to evaluate the quality of existing urban environments to promote walkable cities/communities. The results from using these methods provide policymakers and stakeholders with valuable information regarding the existing physical conditions of the environment. Although several US cities started to develop and refocus plans toward pedestrian-oriented policies approaches, results from this particular study determined that the quality of pedestrian environments cannot solely be determined by using available assessment tools and recommend additional analytical methods used in conjunction with source data to provide a complete perspective to successfully increase the quality of life. The condition of the physical environment – high, average, and low quality – was important contributing factors to increase walkability, yet, it is equally important to understand and consider the needs, preferences and perceptions of end users when public officials are charged with the task of developing plan proposals for pedestrian neighborhoods. This study addresses these issues through a case study examining the quality of pedestrian environment and how people perceive those surroundings of downtown San Luis Obispo.
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Rovithis, Dimitrios. "Econometric methods for evaluating the cost-effectiveness of health care interventions using observational data." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:4138e3c6-8939-48ae-b98e-f42728be5758.
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This thesis explores the use of observational microdata in cost-effectiveness analysis. The application of econometric methods adjusting for selection bias is first reviewed and critically appraised in the economic evaluation literature using a structured template. Limitations of identified studies include lack of good quality evidence regarding the performance of different analytical approaches; inadequate assessment of the sensitivity of their results to violations of fundamental assumptions or variations to crucial estimator parameters; failure to combine the cost and effectiveness outcomes in a summary measure; and no consideration of stochastic uncertainty for the purpose of evaluating cost-effectiveness. Data from the Birthplace national cohort study are used in an attempt to address these limitations in the context of an empirical comparison of estimators relying on regression, matching, as well as the propensity score. It is argued that although these methods cannot address the potential impact of unobservable confounding, a novel approach to bias-corrected matching, combining entropy balancing with seemingly unrelated regression, still has the potential to offer important advantages in terms of analytical robustness. The net economic benefit is proposed as a straightforward way to exploit the strengths of rigorous econometric methodology in the development of reliable and informative cost-effectiveness analyses.
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Goldberg, Marion. "What Paternalism Suggests we Should do About Marijuana in the United States." Scholarship @ Claremont, 2019. https://scholarship.claremont.edu/cmc_theses/2012.
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This thesis provides a framework to understand and apply the philosophical principles of paternalism to determine the most reasonable actions states can take in regard to marijuana legalization. As matters currently stand in U.S. policy, states must decide whether they will prohibit, decriminalize, or legalize marijuana. First, I will give a brief history of marijuana regulations and societal perceptions in the United States. Second, I will define and differentiate concepts of illegalization, decriminalization, and legalization from one another. Third, I will summarize and analyze Joel Feinberg and Sarah Conly's arguments against and for paternalism, respectively. I will conclude by applying the strengths of each philosopher's arguments with respect to the marijuana debate to offer a policy that is both just and effective.
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Saboya, Maria Corcyra Vasconcelos de. "OrganizaÃÃo Social de SaÃde na GestÃo Hospitalar, em Fortaleza: Limites e Possibilidades." Universidade Federal do CearÃ, 2015. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=14388.
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A temÃtica das polÃticas pÃblicas para a saÃde sempre foi um campo importante, uma vez que se trata de um direito social constitucionalmente garantido e que està sempre na pauta de decisÃes dos governantes, objetivando melhorias de gestÃo do sistema de saÃde pÃblica. Nestes termos, verificamos que as decisÃes dos governantes sÃo tomadas conforme o comportamento do Estado, levando-se em conta os aspectos ideolÃgicos e socioeconÃmicos do momento em que cada polÃtica à elaborada. Por meio do PNP, o governo transferiu para âo setor pÃblico nÃo-estatalâ â o chamado terceiro setor â, a produÃÃo dos serviÃos competitivos ou nÃo, exclusivos do Estado, estabelecendo-se um sistema de parceria entre Estado e sociedade para seu financiamento e controle. Portanto, a polÃtica estudada tem concepÃÃo neoliberal que prevà a delimitaÃÃo da atuaÃÃo do Estado da gestÃo de atividades nÃo exclusivas e a transferÃncia para entidades sem fins lucrativos de direito privado. O presente trabalho tem como recorte uma anÃlise da gestÃo de uma OSS, desenvolvida em Hospital PÃblico. Para tanto, consideramos necessÃrio discutir algumas questÃes que irÃo nortear a pesquisa: A gestÃo realizada efetivamente atingiu os resultados almejados pelo modelo de gestÃo? A desconcentraÃÃo das responsabilidades permitiu atingir uma maior agilidade e qualidade no atendimento ao usuÃrio? Quais os pontos fortes e fracos da polÃtica de gestÃo implementada? Para nos aproximarmos da complexidade que envolve estas questÃes iniciais e analisarmos o novo modelo de gestÃo hospitalar implementado sob a gestÃo da OSS, utilizamos um referencial teÃrico crÃtico buscando as mediaÃÃes entre a realidade da gestÃo e as contradiÃÃes que perpassam as questÃes contemporÃneas, com Ãnfase na gestÃo, na organizaÃÃo social, na saÃde, polÃtica pÃblica, avaliaÃÃo. Para tanto, utilizamos um percurso metodolÃgico que se fundamenta no mÃtodo crÃtico compreensivo com aproximaÃÃo ao mÃtodo em profundidade, e seguimos os seguintes passos: estudo bibliogrÃfico, anÃlise documental; sites eletrÃnicos ; observaÃÃo do campo empÃrico, e entrevistas com agentes pÃblicos. Nesta perspectiva, consideramos que conforme pesquisa que conseguimos realizar a gestÃo da OSS com foco nos resultados està se desenvolvendo com dificuldades em atingir as metas ajustadas de forma plena. A eficÃcia e a eficiÃncia nÃo restou comprovada conforme apregoado pelos defensores da Reforma Administrativa. Faltou a realizaÃÃo eficaz do controle do estado articulado com o controle social e ainda a transparÃncia, essenciais a concretizaÃÃo da politica de incentivo Ãs organizaÃÃes sociais. Ainda hà muito a ser feito para consolidaÃÃo da capacidade da OSS de fazer gestÃo do hospital (A) com foco em resultados na perspectiva da reforma administrativa.
40
Zhang, Lei. "Uncompensated Care Provision and the Economic Behavior of Hospitals: the Influence of the Regulatory Environment." Diss., unrestricted, 2008. http://etd.gsu.edu/theses/available/etd-02242009-152847/.
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Thesis (Ph. D.)--Georgia State University, 2008.<br>Title from file title page. Paul G. Farnham, committee chair; Patricia G. Ketsche , Douglas S. Noonan (Ga. Tech.), Shiferaw Gurmu, Karen J. Minyard, William S. Custer, committee members. Description based on contents viewed June 11, 2009. Includes bibliographical references (p. 146-153).
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Chowawa, Rosemary Shanice. "An evaluation of the implementation of capacity building strategies in the provision of health services in the central region of Malawi." Thesis, University of Fort Hare, 2012. http://hdl.handle.net/10353/d1007122.
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The purpose of the study was to evaluate the impact of implementing capacity building strategies on the provision of health services in the central region of Malawi. The study intended to determine why a lack of quality services is still prevailing in the health services in the central region despite implementing capacity building strategies aimed at improving the delivery of health services. In addition to this, to come up with recommendations to improve the implementation of the existing capacity building strategies so that the implementation results in the intended impact, that is efficient and effective provision of health services in the central region of Malawi. The studies reviewed what various scholars have written on capacity building in order to ground capacity building in Public Administration and provide the study with a conceptual, theoretical and legislative framework. This enabled the researcher to describe the nature and place of capacity building in Public Administration. It was evident from the review that the implementation of capacity building strategies is a systematic process which requires that chief officials follow all the steps in order to effectively and efficiently implement the capacity building strategies so that the intended impact is achieved. In this regard, capacity building is a management function which requires that chief officials play an enabling role by providing the necessary resources (both human and financial) and policies that support the implementation of capacity building strategies. The study used both quantitative and qualitative research methods whereby thirty-five respondents composed of political office-bearers and chief officials from Lilongwe, Dedza, Mchinji and Dowa districts and Ministry of Health Headquarters in the central region of Malawi were given self-administered questionnaires to complete. Face-to-face interviews and document analysis were also used as research methods. The intention was to determine the problems that are being experienced in the implementation of the existing capacity building strategies and find out if the strategies are resulting in the intended impact. The study findings confirmed that there are indeed problems being experienced in the implementation of the existing capacity building strategies, namely: inadequate human and financial resources, corruption, political interference, lack of consultation with stakeholders and lack of political will to make sure that the implementation of the capacity building strategies is effectively and efficiently done. It was also revealed that the implementation of the existing capacity building strategies is impacting negatively on the provision of health services in the central region of Malawi, hence indicating a need to change in approach. The study concludes that in order for the capacity building strategies to achieve the intended impact there is a need to broaden the scope of the legal framework on health capacity building strategies in Malawi, enforce the use of performance standards and improve the operational framework to gain efficiencies and effectiveness from current investments in capacity building.
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Robles, Aguilar Gisela. "Targeting efficiency and take-up of Oportunidades, a conditional cash transfer, in urban Mexico in 2008." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:fae519aa-06aa-4f6d-9076-0bf535cd2e66.
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Oportunidades is a Conditional Cash Transfer (CCT) that uses a proxy means-test targeting model to select eligible households for the programme. According to the Income and Expenditure Household Survey of 2008, approximately two in every three eligible rural households participate in Oportunidades, whereas only one in every three eligible urban households receives the Oportunidades cash transfer. This research explores the factors behind this lack of take-up, the costs of participation and the implications of targeting inefficiency on the programme’s impact on income poverty. It argues that a sample selection model is a pertinent tool of analysis as it informs on the distribution of cash transfers conditional on household eligibility. This conditional distribution is also used to understand the costs of participation as a latent variable. Eligible households are less likely to invest in human capital and neither the cash transfer nor the income forgone by children and teenagers are sufficient to overcome these costs of participation. By identifying a method to quantify behavioural change of households, I associate the costs of participation to the difficulties of inducing health-related behavioural change among recipients and eligible non-recipients. At an aggregate state level, targeting inefficiency is not fully explained by only looking at the budget constraints of the programme. In fact, targeting efficiency is positively associated to aggregate behavioural change and negatively associated to aggregate costs for participation at state level. Yet, targeting efficiency does not guarantee impact on income poverty and Oportunidades’ highest impact on income poverty also associated with the inclusion of non-eligible households in the programme. This research reconsiders the importance of the context in which CCTs are implemented and informs on the conflicting aims of CCTs: providing income poverty relief via cash transfers and incentivizing behavioural change by conditioning the cash transfer in health and education investment.
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Stalling, Veda D. "The Phenomenological Evaluation of Social Worker Competencies in Patient-Centered Medical Homes." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/1941.
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The Patient-Centered Medical Home (PCMH) is an innovative, team-based health care model that was applied during the implementation of the Affordable Care Act (ACA). However, the competencies for PCMH health care social worker team members are not identified within this model. Thus, the purpose of this phenomenological study focused on identifying the core competencies that will enable social workers to perform competently in PCMHs. This study also explored the roles and training needs as related to improving the competence of social workers. Sandberg's and Parry's conceptualization of the competency model was used as the theoretical framework. Data were acquired through interviews with 10 PCMH social workers. These data were then inductively coded and analyzed using a modified Moustakas method. Key findings indicated that these social workers believed that improvements in competencies may include training and knowledge with mental health and physical health knowledge which consist of diagnoses, interventions, medications, symptoms, and terminology. It was also noted that knowledge of evidence-based practices for mental health interventions and patient-centered, team-based principles were essential to ACA policy implementation. The positive social change implications of this study include recommendations to health care leadership, educational institutions, and other PCMH providers to develop competency-based training for social workers. Recommendations are also put forth to adapt social work curriculum to ensure the effective implementation of the principles of the ACA policy and to improve social work practice in PCMH health care settings.
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Waters, Heidi C. "Evaluating the Impact of Integrated Care on Service Utilization in Serious Mental Illness." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3374.
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Serious mental illness (SMI) affects 5% of the United States population and is associated with increased morbidity and mortality. Use of high-cost healthcare services is common, including hospitalizations and emergency department (ED) visits. Integrating behavioral and physical healthcare may improve care for consumers with SMI, but prior research findings have been mixed. This quantitative retrospective cohort study addressed the impact of integrated care on physical health and ambulatory care sensitive (ACS) utilization via a program evaluation of an integrated health clinic (IHC) at a community mental health center (CMHC). The research questions assessed whether there was a predictive relationship between IHC enrollment and physical health and ACS-specific service utilization for consumers with SMI when controlling for demographic characteristics and disease severity. Secondary administrative healthcare data, including authorization and electronic medical record data, were provided by the CMHC. Logistic regressions assessed the odds of experiencing an inpatient admission or ED visit before or after IHC enrollment; the predictive relationship between IHC enrollment and service utilization was assessed using multiple linear and Poisson regression analyses. There was no statistically significant impact of integrated care clinic enrollment on physical health or ACS-specific utilization. The sample had lower levels of physical health utilization than would have been expected. In terms of positive social change, results may help the CMHC assess the IHC program, overall clinic success, and use of data. Since policy and payment structures continue to support integrated care models, further research on different programs are encouraged, as each setting and practice pattern is unique.
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Urbonaite, Miglė. "Evaluation of non-pharmaceutical intervention effectiveness in Covid-19 pandemic by using excess mortality metric." Thesis, Södertörns högskola, Miljövetenskap, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:sh:diva-46154.
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INTRODUCTION: The study focuses on finding a methodology for evaluating the effectiveness of the nonpharmaceutical intervention in the face of a new pathogen entering the population. Different interventions can have different effectiveness levels in different populations; thus, studying possible correlations and effectiveness among different groups is essential. With better knowledge of the topic, the outbreak management could be done more cost-effectively, reducing the need for antibiotics, vaccines, and possible reduction of infectious diseases caused burden in developing regions. Furthermore, the study aims to determine the ways of using excess mortality as an evaluation technique for nonpharmaceutical interventions used in the Covid-19 pandemic. METHOD: The variables in time-series format were used to calculate a cross-correlation score alongside other correlation coefficient tests. With the cross-correlation, the lag will be established to estimate how the variables correlate in the timeline. In addition, the study will attempt to establish the connections between different nonpharmaceutical interventions and their strengths and different age groups. RESULTS: The most frequent lag scores identified were 1 with 16 observations and 2 with 9 observations. The highest lag score was 4, which was observed once for the dataset of Hungary. The correlation between excess mortality and different harshness of NPI's was calculated. The correlation coefficient ranges from -0.3 to -0.39, indicating an overall low to medium correlation. The highest correlation was detected with stay-at-home requirements (-0.36), workplace closing (-0.37), and gathering restrictions (-0.39). In the final step, age-based correlations were established. The correlation ranged from 0.26 – 0.36, indicating an overall medium correlation. The lowest correlation can be seen in the youngest age group, 15-64 (correlation coefficient of 0.26), while the highest correlation of 0.36 can be seen in the 75-84 age group. Surprisingly the age group 85+ had a little lower correlation than the 75-84 age group. DISCUSSION AND CONCLUSIONS: A stronger correlation between excess mortality and stringency index was detected in the countries with a higher death per capita. The two groups of intervention effectiveness were established: more effective (school closing, workplace closing, public event limitation, gathering restriction, and stay at home requirement) and less effective (public transport limitation, restriction on internal movement, international travel control, public information campaigns, protection of elderly campaigns). This suggests that NPI effectiveness depends on population size. In the age-group-based analysis, the correlation became stronger with the age increase, indicating nonpharmaceutical intervention effectiveness against high mortality in older adults.
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Marques, Geovana de Oliveira Patrício. "Programa Nacional de Alimentação Escolar: avaliação de resultados no Estado do Ceará." Master's thesis, Instituto Superior de Ciências Sociais e Políticas, 2021. http://hdl.handle.net/10400.5/21602.
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Dissertação de Mestrado em Administração Pública<br>O Programa Nacional de Alimentação Escolar (PNAE), lei federal n° 11.947/2009,
objetiva um maior acesso à alimentação, à construção de hábitos alimentares mais
saudáveis através de práticas educativas, além de promover o controlo social e o
desenvolvimento sustentável, tendo sido em 2014, pela Organização das Nações Unidas
para a Alimentação e a Agricultura (FAO), considerado uma das políticas responsáveis
por tirar o Brasil do Mapa Mundial da Fome. Diante de sua importância, a presente
pesquisa, do tipo ex post, buscou realizar uma avaliação de resultados, analisando os
processos desempenhados, dialogando para isso com o maior número de atores
envolvidos na execução da política, para através do cruzamento destes dados discernir
suas insuficiências no alcance dos objetivos propostos pelo programa. Como conclusão,
não foi constatada uma relação direta entre as regiões ou tipos de escolas e os
resultados encontrados, tendo a insuficiência dos recursos financeiros e o diminuto
número de recursos humanos, trabalhando na execução da política, sido identificados
como as maiores dificuldades.<br>The National School Feeding Program (PNAE), federal law No. 11.947 / 2009, aims at
greater access to food, the construction of healthier eating habits through educational
practices, in addition to promoting social control and sustainable development, having
been in 2014, by the United Nations Food and Agriculture Organization (FAO),
considered one of the policies responsible for taking Brazil off the World Hunger Map.
In view of its importance, the present research, of the ex post type, sought to carry out
an evaluation of results, analyzing the processes performed, dialoguing for this with the
largest number of actors involved in the implementation of the policy, in order to crossreference
these data to discern if its shortcomings achieved the objectives proposed by
the program. As a conclusion, there was no direct relationship between the regions or
types of schools and the results found, with the insufficiency of financial resources and
the small number of human resources, working on the implementation of the policy,
being identified as the greatest difficulties.<br>N/A
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Dantas, Marina Kolland. "Análise da gestão ambiental no Estado de São Paulo: Programa Município VerdeAzul, gastos públicos e indicadores de saúde." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/96/96132/tde-20102016-160116/.
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Como consequência da adoção de modelos insustentáveis de desenvolvimento, a sociedade contemporânea encontra-se diante de um cenário ambiental crítico. Logo, torna-se imprescindível a concepção de políticas públicas direcionadas aos princípios da sustentabilidade. No Estado de São Paulo, desde 2007, o Programa Município VerdeAzul (PMVA) fomenta a gestão ambiental, avaliando o desempenho dos municípios mediante o Índice de Avaliação Ambiental (IAA). A revisão da literatura demonstrou que esse tipo de avaliação é recente e que há uma demanda por estudos multidisciplinares com foco no acompanhamento, análise e compreensão dos diferentes resultados obtidos, da esfera global a local, na construção de ambientes saudáveis. Assim, o presente estudo de caráter quali-quantitativo, descritivo e com desenho espaço-temporal objetivou avaliar a gestão ambiental nos municípios paulistas a partir dos resultados da política pública do PMVA, relacionando-os com os gastos públicos e as condições de saúde da população. Para tanto, foram coletados dados de bases públicas oficiais dos municípios do Estado de São Paulo, entre 2008 e 2013. Após a coleta, procedeu-se a análise a partir das técnicas de estatística descritiva, construção de mapas, análise multinível e correlação. Os resultados evidenciaram que o PMVA é uma política com caráter inovador e contemporâneo, entretanto, há uma descontinuidade na participação de diversos municípios ao longo dos anos, sugerindo que as dinâmicas locais, como pressões de ordem política, podem interferir no comprometimento com essa agenda. As análises demonstraram grandes diferenças intraregionais e inter-regionais quanto ao desempenho em gestão ambiental, com destaque para a predominância de baixas notas no extremo sul paulista. Os dez municípios avaliados com os melhores desempenhos ambientais foram: Novo Horizonte, Santa Rosa de Viterbo, Santa Fé do Sul, Itu, Gabriel Monteiro, Sorocaba, Franca, Piacatu, Dirce Reis e Lins. A análise multinível determinou que o porte populacional não explica a variabilidade no desempenho ambiental, sendo esta reflexo de outras características. As análises quanto ao montante de gastos públicos destinados as funções ambientais também salientaram a inexistência de um padrão definido de investimentos. Esta quantidade de gastos ambientais demonstrou estar ligeiramente e positivamente correlacionada com o IAA, corroborando a associação entre a quantidade de recursos financeiros com a capacidade de gestão ambiental. Quanto à integração saúde e meio ambiente, dentre os principais resultados, destaca-se a ausência de correlação para a mortalidade infantil e que os maiores gastos ambientais foram associados a menores taxas de internação por doenças diarreicas em crianças. Entretanto, estas relações demandam maiores investigações. Conclui-se que esta pesquisa colaborou para o avanço das discussões teóricas sobre gestão ambiental municipal, enfatizando a importância destas ações para o equilíbrio entre o ser humano e os limites planetários. Complementarmente, o estudo contribuiu ao integrar dados públicos diversos, gerando análises que podem melhorar a tomada de decisão pública e, consequentemente, a qualidade ambiental ofertada para a sociedade<br>As a result of the adoption of unsustainable development models, contemporary society is facing a critical environmental scenario. Therefore, it is essential to design public policies to the principles of sustainability. In the State of São Paulo since 2007, the \"Município VerdeAzul\" Program promotes environmental management, evaluating the performance of municipalities by the Environmental Assessment Index (IAA). The literature review has shown that this type of evaluation is recent and there is a demand for multidisciplinary studies focused on monitoring, analysis and understanding of different results, at the global and local level in building healthy environments. Thus, this study of qualitative and quantitative character, descriptive and spatiotemporal design aimed to evaluate the environmental management in the counties from the results of public policy, relating them to public spending and the health conditions of the population. Therefore, data were collected from official public bases of the municipalities of São Paulo, between 2008 and 2013. After collection, the analysis proceeded from the techniques of descriptive statistics, building maps, multilevel analysis and correlation. The results showed that the PMVA is a policy with innovative and contemporary character, however, there is a discontinuity in the participation of several municipalities over the years, suggesting that the local dynamics, as political pressures, may interfere with the commitment to this agenda. Furthermore, analyzes showed large intraregional and interregional differences for performance in environmental management, highlighting the predominance of low grades in São Paulo\'s south. The ten cities evaluated with the best environmental performance were: Novo Horizonte, Santa Rosa de Viterbo, Santa Fé do Sul, Itu, Gabriel Monteiro, Sorocaba, Franca, Piacatu, Dirce Reis, Lins. In this sense, multilevel analysis found that population size do not explain the variability in environmental performance, which is reflective of other features. Analyses on the amount of public spending for environmental functions also highlighted the lack of a defined pattern of investments. The amount of environmental expenses showed to be slightly and be positively correlated with the IAA, corroborating the association between the amount of financial resources to environmental management capacity. Regarding the integration between health and environment, among the main results, there is the lack of correlation for infant mortality, additionally higher environmental expenses were associated with lower hospitalization rates for diarrheal diseases in children. However, these relationships require further investigation. In conclusion, this study helped to advance the theoretical discussions on municipal environmental management, emphasizing the importance of these actions for the balance between human and planetary boundaries. In addition, the study helped to integrate various public data generating analyzes that can improve public decision-making and, consequently, environmental quality offered to society
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Zogahib, André Luiz Nunes. "Estudo de caso da política pública de criação da Fundação Hospital Adriano Jorge: uma avaliação da eficácia da autonomia administrativo-financeira." reponame:Repositório Institucional do FGV, 2008. http://hdl.handle.net/10438/17003.
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Previous issue date: 2008<br>Este trabalho evidencia, no estudo de caso da criação de uma fundação pública de saúde no Estado do Amazonas, a Fundação Hospital Adriano Jorge – FHAJ, como as descentralizações na saúde pública amazonense tendem a ocorrer. Assim, avaliou-se a política pública de criação da FHAJ, no intuito de identificar se os resultados esperados em sua concepção, ganho de autonomia administrativo-financeira, foram efetivamente alcançados. Sobre a luz dos conceitos de políticas públicas, de ciclo de política pública e de avaliação de políticas públicas abordados por diversos autores, além das proposituras de descentralização sugeridas pelo Sistema Único de Saúde e pelo conceito de Fundações Públicas, buscou-se verificar se houve um aumento dos serviços prestados ou melhora de sua qualidade. Desta forma, evidenciou-se, também, variáveis que pudessem expressar o ganho, a perda ou a manutenção do nível de autonomia administrativo-financeira do Hospital Geral Adriano Jorge, após sua transformação em Fundação Pública.<br>This work proposes to present the case of the public policy for creation of a public health foundation in the state of Amazonas, the Adriano Jorge Hospital Foundation – FHAJ. Thus, the aforementioned public policy was evaluated, attempting to identify whether the results expected at its conception – increase in administrative-financial autonomy – effectively came about. Preliminarily, we identified the concepts of public policy, the cycle of public policy and of evaluation of public policies broached by several authors, besides evidencing the propositions of decentralization suggested by the Single Health System and by the concept of Public Foundations. The budget and administrative results from 2002-2007 were shown, and a tendency to decrease was verified, which accentuated in the last year, indicating a possible excessive administrative-financial dependence.
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Wilks, Chrisanne. "Factors Associated with Client Satisfaction at Community-based Mental Health Agencies in Ohio." The Ohio State University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=osu1448966548.
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Song, Zirui. "Financial Incentives in Health Care Reform: Evaluating Payment Reform in Accountable Care Organizations and Competitive Bidding in Medicare." Thesis, Harvard University, 2012. http://dissertations.umi.com/gsas.harvard:10177.
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Amidst mounting federal debt, slowing the growth of health care spending is one of the nation’s top domestic priorities. This dissertation evaluates three current policy ideas: (1) global payment within an accountable care contracting model, (2) physician fee cuts, and (3) expanding the role of competitive bidding in Medicare. Chapter one studies the effect of global payment and pay-for-performance on health care spending and quality in accountable care organizations. I evaluate the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract (AQC), which was implemented in 2009 with seven provider organizations comprising 380,000 enrollees. Using claims and quality data in a quasi-experimental difference-in-differences design, I find that the AQC was associated with a 1.9 percent reduction in medical spending and modest improvements in quality of chronic care management and pediatric care in year one. Chapter two studies Medicare’s elimination of payments for consultations in the 2010 Medicare Physician Fee Schedule. This targeted fee cut (largely to specialists) was accompanied by a fee increase for office visits (billed more often by primary care physicians). Using claims data for 2.2 million Medicare beneficiaries, I test for discontinuities in spending, volume, and coding of outpatient physician encounters with an interrupted time series design. I find that spending on physician encounters increased 6 percent after the policy, largely due to a coding effect and higher office visit fees. Slightly more than half of the increase was accounted for by primary care physician visits, with the rest by specialist visits. Chapter three examines competitive bidding, which is at the center of several proposals to reform Medicare into a premium support program. In competitive bidding, private plans submit prices (bids) they are willing to accept to insure a Medicare beneficiary. In perfect competition, plans bid costs and thus bids are insensitive to the benchmark. Under imperfect competition, bids may move with the benchmark. I study the effect of benchmark changes on plan bids using Medicare Advantage data in a longitudinal market-level model. I find that a $1 increase in the benchmark leads to about a $0.50 increase in bids among Medicare managed care plans.