Measuring the impact of the Affordable Care Act Medicaid expansion on access to primary care using an interrupted time series approach.

Background: The Patient Protection and Affordable Care Act of 2010, commonly referred to as the Affordable Care Act (ACA), was created to increase access to primary care, improve quality of care, and decrease healthcare costs. A key provision in the law that mandated expansion of state Medicaid programme changed when states were given the option to voluntarily expand Medicaid. Our study sought to measure the impact of ACA Medicaid expansion on preventable hospitalization (PH) rates, a measure of access to primary care.

Effect of the Economic Recession on Primary Care Access for the Homeless.

Primary care access (PCA) for the homeless can prove challenging, especially during periods of economic distress. In the United States, the most recent recession may have presented additional barriers to accessing care. Limited safety-net resources traditionally used by the homeless may have also been used by the non-homeless, resulting in delays in seeking treatment for the homeless.

Medicaid managed care reduces readmissions for youths with type 1 diabetes.

Objectives: To determine whether the likelihood of readmission (adjusted for severity on first admission) for pediatric type 1 diabetes (T1D) differs between Medicaid managed care and non-managed care.

Study Design: De-identified patients were retrospectively selected from the Pediatric Health Information Systems database of the Children's Hospital Association (CHA). The cohort of 42 hospitals across 25 states included discharges between 2008 and 2011 for patients who were receiving Medicaid at the time of service and had T1D as their diagnosis.

Key stakeholder perceptions regarding acute care psychiatry in distressed publicly funded mental health care markets.

The role of acute care inpatient psychiatry, public and private, has changed dramatically since the 1960s, especially as recent market forces affecting the private sector have had ripple effects on publicly funded mental health care. Key stakeholders' experiences, perceptions, and opinions regarding the role of acute care psychiatry in distressed markets of publicly funded mental health care were examined. A qualitative research study was conducted using semi-structured thematic interviews with 52 senior mental health system administrators, clinical directors and managers, and nonclinical policy specialists.

The Master Settlement Agreement and its impact on tobacco use 10 years later: lessons for physicians about health policy making.

The issue of tobacco industry responsibility for population health problems and compensation for their treatment has been growing since the 1960s. In 1999, the state attorneys general collectively launched the largest class action lawsuit in US history and sued the tobacco industry to recover the costs of caring for smokers. In what became known as the Master Settlement Agreement (MSA), states were rewarded billions of dollars and won concessions regarding how cigarettes could be advertised and targeted to minors.

Comparison of Markov model and discrete-event simulation techniques for HIV.

Background: Markov models have been the standard framework for predicting long-term clinical and economic outcomes using the surrogate marker endpoints from clinical trials. However, they are complex, have intensive data requirements and are often difficult for decision makers to understand. Recent developments in modelling software have made it possible to use discrete-event simulation (DES) to model outcomes in HIV.

Cost effectiveness of lopinavir/ritonavir tablets compared with atazanavir plus ritonavir in antiretroviral-experienced patients in the UK, France, Italy and Spain.

Background And Objective: Selection of antiretroviral therapy (ART) for antiretroviral-experienced patients should involve balancing multiple factors, including clinical efficacy, adverse-event risk, resistance concerns, cost effectiveness and expected budget impact. The efficacy of a regimen and its durability, as demonstrated in controlled clinical trials, must be considered in the light of short- and long-term economic impacts on the healthcare system. These impacts may vary based on drug costs, costs of reported adverse effects, the regimen's likelihood of contributing to viral resistance to second-line therapies and the marginal cost differences between other healthcare resources used over a patient's lifetime.

Practices in public health finance: an investigation of jurisdiction funding patterns and performance.

A field of study for public health finance has never been adequately developed. Consequently, very little is known about the relationships, types, and amount of finances that fund the public health system in America. This research was undertaken to build on the sparse knowledge of public health finance by examining the value of performance measurement systems to financial analysis.

Human and ecosystem health: the environment-agriculture connection in developing countries.

Agricultural productivity and the health of farming populations are both influenced by environmental change. Farming activities also affect the environment. Six principal dimensions of this agriculture/environment interrelation are explored: water resources; erosion and nonpoint source pollution; pesticides and fertilizers; deforestation; population pressures; and biodiversity.

Policy and organizational issues in agromedicine: a survey of 2001 NAAC meeting attendees.

The field of agromedicine faces numerous policy and organizational development challenges as it enters the 21st Century. To gauge these, the authors surveyed attendees of the 14th Annual Meeting of the North American Agromedicine Consortium (NAAC) in Charleston, South Carolina, in November 2001. Survey questions dealt with agromedicine policy issues, organizational/programmatic issues, the agromedicine core areas, the usefulness of state reports at the meeting, and important policy, organizational and programmatic issues that were missing from, or insufficiently covered at the meeting.