Major Concepts of Health Care Administration
Western Kentucky University
Major Concepts of Health Care Administration
Affordable Care Act
Bustamante, A. V., & Chen, J. (2018). Lower barriers to primary care after the implementation of the Affordable Care Act in the United States of America. Revista Panamericana de Salud Pública, 42, e106.
This article evaluates how the Affordable Care Act (ACA) affected adults’ perception of barriers in accessing primary care. To obtain the “before” information, data from the National Health Interview Survey (NHIS) was utilized, covering 2011-2014. The “after” data revealed that overall, responding adults perceived fewer barriers to accessing primary care. The article addresses how the 2018 tax reform could have a negative effect on reducing barriers due to removing the incentive for people to obtain insurance coverage. Overall, the article addresses how the ACA reduced the barriers to accessing primary care and revealed the need for additional research with objective measures.
Kermani, M., Goudarzi, G., Shahsavani, A., Dowlati, M., Asl, F. B., Karimzadeh, S. … ; Ghorbani-Kalkhajeh, S., (2018). Estimation of Short-term Mortality and Morbidity Attributed to Fine Particulate Matter in the Ambient Air of Eight Iranian Cities. Annals of Global Health, 84(3), pp.408-418.
This article addresses the mortality and morbidity associated with ambient air pollution. By determining the number of people affected by air pollution, it is possible to determine that current standards for air quality are not enough. The article points out that concerns about air pollution have increased, especially in developing countries. The methodology utilized the AirQ model and data from the Iranian Environmental Protection Agency. The article showed that it is imperative to create measures that will lead to the reduction and control of air pollution.
Health Promotion and Disease Prevention
Inman, D. D., van Bakergem, K. M., LaRosa, A. C., ; Garr, D. R. (2011). Evidence-based health promotion programs for schools and communities. American Journal of Preventive Medicine, 40(2), 207-219.
This article looks at the objective of Healthy People 2020 regarding comprehensive school health education. By performing a comprehensive literature review, the article was able to suggest programs, strategies and resources that were evidence-based and peer-reviewed. Effective programs were determined to have the following qualities: clear health goals, identifying specific types of behaviors, address the psychosocial risk and protective factors. The article acknowledged the fact that having effective evidenced-based programs is vital, but effective implementation is fundamental to the success of these programs.
Medicare and/or Medicaid
Oliver, G. M., Pennington, L., Revelle, S., ; Rantz, M. (2014). Impact of nurse practitioners on health outcomes of Medicare and Medicaid patients. Nursing Outlook, 62(6), 440-447.
This article evaluates the correlation between the Advanced Practice Registered Nurses (APRN) practice level and health outcomes in Medicare or Medicare-Medicaid beneficiaries. The method utilized compared the level of APRN practice with state rankings of patient outcomes. Data has long shown that patient outcomes with NPs are equal to, if not better than, the outcomes with physicians. The article determines that NPs with full practice privileges have better health outcomes than those with restricted practice privileges. The article supports the demand of allowing APRNs full practice privileges. Removing barriers to the level of practice will allow for positive change and outcomes related to health care costs and quality of care.
Universal Health Care Coverage
Tang, S., Tao, J., ; Bekedam, H. (2012, June). Controlling cost escalation of healthcare: making universal health coverage sustainable in China. In BMC public health (Vol. 12, No. 1, p. S8). BioMed Central.
In this article, the authors evaluate the issue of rising costs of universal health coverage in China. The current methods of cost containment are evaluated, and deficiencies are identified, as well as common complaints of poor quality of care due to the pressure of reducing costs. The proposed alternatives or reforms to existing methods seek to further contain costs while improving access parity, efficiency, and excellence in care.
Within the proposed modifications or alternatives to current methods, the authors identify both the advantages and disadvantages of each. The complexity of healthcare cost reduction is acknowledged, and while there is no one method that will be perfect, improvements can be made.
Health Care Reform
Obama, B. (2016). United States health care reform: progress to date and next steps. Jama, 316(5), 525-532.
This Special Communication addresses the importance of the Affordable Care Act (ACA). Elements that led to the conclusion that transforming the health care system in the United States was imperative are identified. It reviews the how the changes mandated by the ACA have affected the health care system and identifies ways in which policy makers could further develop the legislation. In order to support these findings, the author utilized data spanning over fifty years. The desired effect of the ACA was to help shift health care from a quantity/profit-based system to a quality-based system. That goal is being achieved and will continue to be, provided legislators used data proven information to shape their decision making.
Person Centered Care in Nursing Homes/Nursing Facilities
Brownie, S., ; Nancarrow, S. (2013). Effects of person-centered care on residents and staff in aged-care facilities: a systematic review. Clinical Interventions in Aging, 8, 1.
The purpose of this article was to identify what effect aged-care facilities had on residents and staff when they transitioned from a biomedical model to a person-centered care model. The resources that ultimately were utilized in evaluating these effects were chosen after searching through nearly twenty years of studies. An initial pool of 323 potential articles was whittled down to just nine articles based on inclusion criteria. The authors are careful to note that there was a potential for bias due to limitations in study designs.
Person-centered interventions are multifactorial, yet only one type of intervention was shown to utilize each of the factors. This was the Eden Alternative. Residents who receive person-centered care had mostly positive outcomes; though a couple studies did indicate that these residents were at higher risk for falls. Because of this increased risk, it is suggested that further research be dedicated to conducting environmental safety audits. Despite the varying methodologies in the studies that were referenced, it was clear that person-centered interventions had positive outcomes in both the residents and the care staff.
Accountable Care Organizations
McWilliams, J. M., Chernew, M. E., Landon, B. E., ; Schwartz, A. L. (2015). Performance differences in year 1 of pioneer accountable care organizations. New England Journal of Medicine, 372(20), 1927-1936.
In this article, the first-year cost savings effectiveness of Accountable Care Organizations is evaluated. The method used is difference-in-difference analysis. Compared was the Medicare dollars spent on beneficiaries to ACO groups versus to other beneficiaries. The results of this study indicated that the savings were varied due to differences in baseline spending levels.
A number of limitations were identified and ultimately indicate a need for much further investigation as several factors cannot be adjusted for until additional studies are done. The costs associated with administration and implementation need be better understood in order to be adjusted for as well. The article’s current conclusions are not able to be applied across the board to other providers.
Glanz, J. M., Newcomer, S. R., Narwaney, K. J., Hambidge, S. J., Daley, M. F., Wagner, N. M., … & Nelson, J. C. (2013). A population-based cohort study of undervaccination in 8 managed care organizations across the United States. JAMA pediatrics, 167(3), 274-281.
The article details a retrospective cohort analysis. Information from eight Managed Care Organizations was utilized and approval from each organization’s IRB was obtained. There were strict criteria for inclusion in the study in order to ensure the child had received adequate care prior to and while enrolled in the study. Calculated was the mean number of days considered to be under-vaccinated and determining if a parent’s choice to delay or refuse vaccination was due to personal choice and not out of medical necessity.
The results of this evaluation determined that under-vaccination increased dramatically during the cohort period. The true magnitude of under-vaccination is likely underestimated due to the fact that children who are under-vaccinated are less likely to be taken for routine medical care. Despite mountains of evidence supporting the safety and efficacy of vaccinations, delayed vaccination or flat out refusal of vaccinations is on the rise.
Infant Mortality Rate
MacDorman, M. F., Mathews, T. J., Mohangoo, A. D., & Zeitlin, J. (2014). International comparisons of infant mortality and related factors: United States and Europe, 2010.
The high infant mortality rate of the United States compared to countries in Europe is evaluated. The purpose of this evaluation is to determine the reasons for the stark differences in infant mortality rates. At the time the comparison was performed, the most recent data regarding infant mortality rates was obtained. Due to the differences in reporting and classification, parameters were set and data outside of these parameters were excluded from the comparison. In addition, the Kitagawa method was utilized to further enumerate variables that were continuously evolving.
Preterm birth appears to be the highest contributing factor to infant mortality rates in the United States, followed by a high rate of infant mortality in babies born after 37 weeks. A reduction in the number of preterm births would substantially improve the rate of infant mortality in the United States. While the United States has made great effort to continue to bring the rate of preterm births down, it still stands to have the highest rate of preterm birth and infant mortality compared to most European countries. Determining the causes of infant mortality not related to preterm birth is also essential to reducing this rate.