System Structure & Performance-Effects of Policy Change
Room: Thoroughbred 2
Wednesday, April 9, 2014, 2-3:15 pm
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KC14 Session 4B on System Structure & Performance: Effects of Policy Change by NCC for PHSSR
MODERATOR
Wiliam Mase, Ph.D.
PRESENTERS
Gulzar Shah, Ph.D., M.S., M.Sc., B.S.
LHDs’ implementation and evaluation of strategies to target psychological, mental health and other behavioral healthcare needs of the underserved populations
Co-Investigators: Huabin Luo, Ph.D., Carolyn Leep, M.P.H, M.S., Nancy Winterbauer, Ph.D., M.S.
Background: Underserved subgroups face barriers when accessing behavioral healthcare. Local health departments (LHDs) are charged with “linking people to needed personal health services and assure the provision of healthcare when otherwise unavailable”.
Research Objectives: 1) To assess the extent to which LHDs implement and evaluate strategies to target the behavioral healthcare needs for the underserved populations; 2) To identify factors that are associated with these undertakings.
Datasets and Sources: Data were drawn from the 2013 National Profile of Local Health Departments Study conducted by National Association of County and City Health Officials The Module 2 questionnaire of the Profile contained question about strategies used by LHDs to target the behavioral healthcare needs of the underserved populations (N=505).
Study Design: Cross-sectional, quantitative survey.
Analysis: Factors associated with assuring access to behavioral health services were examined by using logistic regression analyses. Descriptive statistics were also computed. To account for complex survey design, we used SVY routine in Stata 11.
Principal Findings: About 30% of LHDs implemented or evaluated strategies to target the behavioral healthcare needs of underserved populations in their jurisdiction. Our multivariate analysis indicates that LHDs with city/multicity jurisdiction (AOR=0.16, 95% CI: 0.04-0.77), centralized governance (AOR=0.12, 95% CI: 0.02-0.85), and those located in the South Region (AOR=.0.25, 95% CI: 0.08-0.14) or the West Region (AOR=.0.36, 95% CI: 0.14-0.94) were less likely to have targeted the behavioral healthcare needs of the underserved. LHDs with higher per capita expenditures (AOR=1.85, 95% CI: 1.00-3.42), or those with greater number of activities to address health disparities (AOR=1.27, 95% CI: 1.08-1.49) had higher odds of having targeted the behavioral healthcare needs of the underserved.
Conclusion: Extent to which the LHDs implemented or evaluated strategies to target the behavioral healthcare needs of the underserved populations varied by centralization of governance, the degree to which LHDs were well-funded, health disparities reduction activities, geographic region, and jurisdiction type.
Implications for Public Health: Policy and practice focus on mental health issues in under-served populations is ever more critical, given the low proportion of LHDs targeting behavioral health needs, and the increased vulnerability of underserved population emanating from recent financial crises.
Erika Martin, Ph.D., M.P.H.
Quantifying the Public Health Impact of State Policies to Address Organ Shortages in the United States
Co-Investigators: Paula Chatterjee, M.P.H., Anitha Vijayan, M.D., Jason Wellen, M.D., M.B.A., Atheendar Venkataramani, M.D., Ph.D.
Background: The shortage in transplantable solid organs remains a critical public health challenge in the United States. States have enacted numerous policies aiming to increase organ supply, but their effectiveness is unknown.
Research Objective: We examined the impact of different state policies on organ donation rates from 1988 to 2010. Data Sets and Sources: Data on the number of live organ donors and the enactment of state policies came from the United Network for Organ Sharing and the Organ Procurement and Transplantation Network databases, state legislative websites, Westlaw, and other web sources.
Study Design: We used difference-in-differences regression analysis to compare pre- and post-legislation changes in living organ donation rates in states that enacted each policy (first-person consent laws, donor registries, dedicated revenue streams for donor recruitment activities, population education, paid leave for donors, and tax incentives) to those that did not.
Analysis: Descriptive analyses documented national trends. Multivariate analyses controlled for income per capita, percent uninsured, population with end-stage renal disease, state and year fixed effects, and state-specific time trends.
Principal Findings: The number of organ donors increased nationally from nearly 9,000 to 14,000 from 1988 to 2010. Establishing revenue policies was associated with an 11% increase in organ donation rates (95% CI: 3.0-19.6%). Policies establishing educational campaigns had a modest but insignificant effect (7.89% increase, 95% CI: -0.59–16.4%). No other state policy had a statistically significant impact on donation rates. Findings were robust to multiple regression model specifications.
Conclusions: Increases in national organ donation rates may be partially attributable to state-based dedicated revenue funds. Other policies had a minimal effect. The mechanism by which such funds lead to increased donation remains unclear, but may be due to greater allowance of specific resources for local, high-impact donation promotion activities.
Implications for Public Health Practice and Policy: Systematically evaluating the effectiveness of state policy solutions is critical to guiding future public health practice. Promoting the use of protected state funds for organ donation is promising, although understanding the pathway by which these policies increase donation requires more granular community-level data.
Michael Preston, Ph.D., M.P.H.
Health Care Reform: Colorectal Cancer Screening Expansion, Before and After the Affordable Care Act (ACA)
Co-Investigators: None Listed
Background: Colorectal cancer (CRC) is the third most common cancer found in men and women in the United States. In 2012, the American Cancer Society estimated as many as 143,460 new cases of colorectal cancer and approximately 51,690 deaths. Health care reform was introduced in 2010 and became the cornerstone for Americans seeking change in the health care system. Health care reform is a critical factor in increasing CRC screenings by increasing coverage rates for all Americans.
Research Objective: To estimate the effects of health insurance coverage expansions on overall CRC screening rates.
Data Sets and Sources: Secondary data were analyzed from the Behavioral Risk Factor Surveillance System and National Cancer Institute State Cancer Legislative Database from 1997-2012. The target population was a sample of U.S. adults age 50 to 74 that lived in a mandate or non-mandate states before and after health care reform.
Study Design: Retrospective cohort study using a strong quasi-experimental design to examine mandate variations and the effect on overall CRC screening from 1997-2012.
Analysis: A time-series analysis using a difference-in-differences approach was used to examine the effect of health care reform on non-mandate states.
Principal Findings: The adjusted average marginal effects from the difference-in-differences model indicates that health care reform increased the probability of being “up-to-date” relative to being non-compliant by 3.4 percentage points, suggesting that an estimated 2.87 million additional age-eligible persons would receive a screening after health care reform annually. Our findings are robust to different model specifications.
Conclusions: Health care reform that lowers out-of-pocket costs is an effective approach to increase colorectal cancer screenings.
Implications for Public Health Practice and Policy: With the introduction of the Affordable Care Act, responsive public health systems require strategies to determine which policies, systems, and administrative strategies are most effective in reducing health disparities. This research demonstrates that insurance mandates increased colorectal cancer screenings by reducing out-of-pocket costs. Future health care reforms that increase access to preventive services, such as CRC screening, are likely with low out-of-pocket costs and will increase the number of people who are “up-to-date”.