bluuebunny/crossref_metadata_2025 huggingface dataset:
Strategic Implementation: An Illustration of Theory/Practice Disconnect in Public Administration
Authors: Mitchell David
Published: May 2024

Public administration scholars and practitioners alike struggle to promote the effectiveness of government and its institutions in the current political and policy environments. Successful implementation of government strategic initiatives is a vehicle to improve responsiveness and results to the public. However, the disconnect between public administration scholars and practitioners threatens its utility. The case of strategic implementation demonstrates the scholar/practitioner divide and illustrates how such a gap can hamper government effectiveness, as shown by comparing the empirical prescriptions from a recent study on strategic implementation in US municipalities to the practical reality within the same sample. Public organizations utilized generic approaches to implementation where contingent ones are empirically prescribed. Further, the contingent application of implementation tools did not mirror those recommended in prior scholarly study. As a whole, this disconnect reduced implementation success by over 20 percent. The study recommends steps to increase the use of scholarly research in practice.
Practical Applications of Ecological Consultation in Higher Education: Diversity and Inclusion Initiatives
Authors: Williams Stacy A. S. , Conyers Addrain , Garcia Freddimir
Published: May 2024

This article adapts the model of ecological consultation to promote diversity and inclusion in higher education. Practical applications of ecological consultation aligned with systems theory will be shared to assist an organization in systems change. The ecological branch of consultation provides guidelines that can be utilized by change agents to lead the charge for a more inclusive environment. Examples steeped in both theory and practical applications will provide guidance for others thinking of leading this process at their institutions.
Merging during A Time of Fiscal Crisis: A Financial Condition Analysis of the Augusta-Richmond City-County Consolidation
Authors: Meares Wesley , Hatcher William , Roberts Courtney
Published: May 2024

City-county consolidation is an administrative reform prescribed to improve the fiscal health of local governments in the United States. However, city-county mergers are rare political events, and scholarship has presented mixed findings regarding the effectiveness of the reform as a fiscal tool. In the history of the nation, only around 40 cities and counties have merged, and this relatively small number imposes limitations on research into the phenomenon (Jespon, 2008). In this paper, we examine the effectiveness of consolidation in improving the fiscal health of local governments using a case study analysis, examining pre- and post-measures of fiscal health in Augusta, Georgia, in the period from 1990–2002. These measures were based on work by Rivenbark, Roenigk, and Allison (2010), Smith and Afonso (2016), and Kelly and Adhikari (2012). The findings from this study are of interest to public administrators regarding the effectiveness of city-county consolidation as a fiscal tool.
Evidenced Based Policy Decisions & Population Health: Policies, Disparities, and Data Integrity
Authors: Knepper Hillary , Sonenberg Andrea , Savage Paul
Published: May 2024

The surfeit of health policy research in the health care literature is concomitant with the dearth in the public administration literature, although billions of public dollars are spent annually on healthcare. The purpose of this paper is to shed light on a critical flaw in our ability to accurately analyze the contributions of efficient and effective healthcare practitioners who hold the potential to substantially improve health care equity in the United States. Developing adequate primary care workforce capacity may depend on modernizing state regulatory policies. However, this decision must be based on clear evidence. Evidence related to service delivery and health outcomes for the US’ most vulnerable groups relies on the availability of valid, reliable, quality data. The Centers for Medicare and Medicaid database is the most logical and comprehensive data source. Yet, this intergovernmental and privatized program presents significant data obstacles. In seeking to analyze health policies using Medicaid data, significant data quality concerns emerged. Specifically, nurse practitioner and physician assistant services were under-represented in the datasets analyzed. This underestimates their true contributions to primary care and subsequently impairs our ability to analyze the true cost of primary care service delivery. Why is this important? In an era of healthcare transitions and changing reimbursement mechanisms, the ability to conduct valid investigations into Medicaid services is necessary to accurately inform regulatory and programmatic policy analysis and reform. Improvements in Medicaid data collection will contribute to improving data integrity, thus enabling better evidence based solutions for addressing crippling healthcare fiscal challenges. This study contributes three key findings, the adaptation of a model for data integrity in public administration, and concludes with making three recommendations for improving the utilization and reporting of critical evidence on which to base future health policy.
Does Size Count down Under? Australian School Performance, School Size and Public Policy
Authors: Drew Joseph , Kortt Michael A. , Fahey Glenn
Published: May 2024

In principle, education research might be expected to yield evidence on the determinants of success that could then be used to inform public policy. However, if key determinants are missing from empirical specifications, then public policy decisions may well be made in a vacuum. Moreover, if empirical work is informed by disparate conceptual approaches, then public policies may be formulated, which ultimately work at cross-purposes. We examine the issue of school size from both the economic and the ecological perspective. Our regressions on a seven year panel of Australian data suggest that there is a trade-off to be made between efficiency on the one hand, and the desire to lift academic standards on the other. Failure to consider the question of school size from both economic and ecological perspectives means that an important public policy lever has largely gone unrecognised in Australia. We conclude our essay with a consideration of the public policy implications arising from our work.
Politics or Professionalism to the Rescue? The Friedrich-Finer Debate in the Context of State Intervention in Michigan
Authors: Wang Shu , Crosby Andrew
Published: May 2024

Who should come to the rescue when a local government is fiscally ailing: professionals or politicians? Michigan Public Act 436 of 2012 authorizes state government to intervene in local fiscal affairs by appointing emergency managers. Political officials and residents have resisted such interventions, arguing political officials should restore fiscal health. This conflict illustrates a classic accountability debate between Carl Friedrich and Herman Finer in public administration literature: that between technical merit and political control. Using interviews with state and local managers as well as elected officials, we explore whether bureaucrats and emergency managers view accountability differently than elected officials when under state intervention. We find emergency managers and local bureaucrats tend to adopt Friedrich's view that technical merit should drive decisions, and elected officials tend to adopt Finer's view that restoring financial health should be a politically driven process. Finally, we offer suggestions for state and local collaboration moving forward.
Exploring how Transit Practitioners Navigate Nervousness
Authors: Larson Samantha
Published: May 2024

This study explores how practitioners navigate feelings of nervousness associated with racial and economic inequities connected to public transit systems. It utilizes Gooden's (2014) 10 principles for conquering nervousness, which have received little attention in the literature to date. This preliminary investigation thus examines the extent to which the principles are adopted – or not – by transit practitioners across four diverse metropolitan areas. A purposive sample of transit equity experts led to 12 in-depth interviews. The analysis illustrates varying degrees of principle adoption amongst the participants. Findings suggest that external legal triggers (such as Title VI of the Civil Rights Act of 1964) most often move the needle on racial equity in public transit. The least adopted principles indicate that agencies are less likely to adopt a race-conscious approach, limiting acknowledgement of historical inequities and structural barriers, which allows nervousness to linger and inequities to persist on a societal level.
Understanding Transparency Practices in Private Foundations
Authors: Jung Jihye
Published: May 2024

Despite the increasing attention to transparency among academics and practitioners, researchers face a significant challenge in gaining access to foundation information, which limits their ability to study foundation transparency. This research aims to advance our understanding of foundation transparency by exploring various dimensions of transparency, including public visibility, information disclosure, external relational activities, reporting quality, and the timeliness of information. The study uses IRS Form 990-PF e-file datasets from 2011 to 2016, as well as information collected from foundation websites. Foundations with websites were coded using content analysis, and a transparency index was constructed through principal factor analysis. The findings indicate that only around one percent of foundations maintain a website, and publicly available information is skewed towards administrative information with a lack of financial information and information on external relations-building activities. Additionally, the average time taken to file after the tax deadline was approximately four months, and tax filings were found to have reporting quality issues.
Life and Liberty: The Power of Positive Purpose
Authors: Gragnolati Brian A. , Stupak Ronald J.
Published: May 2024

The authors believe that health care and the courts, through their commitments to positive purpose, are the fundamental keepers of life and liberty in American society. In fact, they postulate that the power of positive purpose works in every sector—public, private, and not-for-profit. More specifically, by the use of data, operational examples, and cases, this article shows how high performing hospitals, courts, and other organizations make optimism tangible by developing concepts, theories, and policies based on positive values. Effective court and hospital leaders take the abstractions and hopes of wishes and dreams and make them concrete and operational in a caring, sensitive, and humane way.

Increasingly with the new generation of employees, loyalty and motivation are based more on affirmative values anchored in empowerment, participation, involvement, and spirituality than on cash. Leaders in health care and the courts must possess and be able to communicate a clear set of positive values to these individuals. Consequently, the authors show that we in health care and the court arena can influence the events in our personal lives and in our organizations’ lives by making the values, visions, and cultural anchors in our organizational settings the foundations of performance.

Strong leadership that ties the organizational goals to uplifting values based on a committed sense of optimism is the key to confronting creatively the philosophical, strategic, organizational, and operational changes necessary to improving the institutional effectiveness of health care and the law as we move into the new millenium. As reflective-practitioner leaders, it is our responsibility to be the catalysts and role models for our professional colleagues by retaining, communicating, and demonstrating a profound sense of optimism and a high level of performance in judicial and health care organizations.
HMO Middle Manager Perceptions of the Legality of Specified Practices
Authors: Peterson Robin T.
Published: May 2024

If Health Maintenance Organizations (HMOs) are to survive and prosper, they must abide by a large volume of potentially disruptive laws and regulations at the federal, state, and local levels. Some have suffered extreme financial loss and even been driven out of business because of legal transgressions. This study explores the ability of middle managers in large and small HMOs to distinguish between legal and illegal practices in light of federal laws. The study uncovered evidence of lack of this ability especially for managers in small HMOs. Various remedial measures are proposed for this problem.
Linking Public Relations Processes and Organizational Effectoveness at a State Health Department
Authors: Wise Kurt
Published: May 2024

This qualitative case study explored a state health department's relationships with strategic constituencies from a public relations perspective. The relationships were explored within the theoretical framework of the Excellence Theory, the dominant paradigm in public research. Findings indicate application of the Excellence Theory has the potential to increase organizational effectiveness at public health entities. With respect to the case investigated, findings indicate that the state health department could increase its organizational effectiveness through the adoption of recommendations based on the Excellence Theory.
Reducing Disparities in Utilization of Mamography: Reaching Dually Eligible Women in Connecticut
Authors: Barr Judith K. , Kelvey-Albert Michelle , Curry Maureen , Gaudiosi Alisa , Testa Katie , Elwell Anne , Petrillo Marcia , Meehan Thomas P.
Published: May 2024

This article describes a two-pronged intervention by the health care Quality Improvement Organization (QIO) for Connecticut to address the disparity in rates of mammography screening between women eligible for both Medicare and Medicaid ( i.e., “dually eligible”) and other Medicare beneficiaries. The interventions were directed beneficiaries. One intervention addressed information and access needs of the target population: an education session was followed by a mobile mammography van session at low-income housing sites in specific geographic areas. The second intervention was a culturally-sensitive direct mailing to dually eligible beneficiaries across the state. Implementation methods are described including: defining and identifying the target population; specifying the disparity; developing community collaboration; and testing the mail materials.

Preliminary results of the education sessions and community testing of the direct mail materials generated information about the target population. Issues in implementation and analysis include: reaching the target population, building community relations, and developing design approaches to test the intervention.
The Social Security Amendments of 1960: Completing the Foundation for Medicare and Medicaid
Authors: Peters Robert Andrews
Published: May 2024

The expansion of social security coverage enabled northern, industrial states to transfer a larger share of their Old Age Assistance (OAA) clients to the Social Security (OASDI) rolls at an earlier date than was possible in southern, agricultural states. Due to the differential rate of transferring clients, northern states could achieve a larger financial return from the establishment of Medicare while an increase in federal medical reimbursement for public assistance clients was more beneficial to southern jurisdictions. Although public opinion overwhelmingly supported the former option, partisan presidential politics and a split in the Democratic ranks enabled southern Democrats to thwart the will of the people by enacting legislation that significantly expanded federal contributions for the health care of indigent, elderly citizens. The evidence, therefore, indicates that regional differences in the share of elderly citizens receiving OASDI and OAA benefits contributed to the suppression of Medicare amendments. It is also evident that, in the absence of a presidential veto threat, southern opposition to Social Security health insurance would have been muted and Congress may gave enacted Medicare legislation in 1960 instead of 1965.
Activism in an Age of Restraint: The Resiliency of Administrative Structure in Implementing the State Children's Health Insurance Program
Authors: Plein L. Christopher
Published: May 2024

This article examines, state efforts to build administrative structures and outreach networks in the State Children's Health Insurance Program (CHIP) through a comparative review of 18 states that have been the subject of ongoing research by the Nelson A. Rockefeller Institute of Government. The article explores the role that institutional structures play at the state level in shaping the implementation and administration of federal policy choices. States have generally opted to rely largely on existing Medicaid bureaucracies in order to implement the new CHIP programs. As a result. CHIP programs have been tightly integrated into existing Medicaid structures. Rarely put forward as exemplars of responsiveness and. these bureaucracies have nonetheless played a crucial role in building and managing CHIP programs across the United States. As this analysis will show, this has even been the case in those few states that have opted to officially house CHIP administration outside of the Medicaid bureaucracy. Furthermore, existing Medicaid systems have often been active as partners and participants in efforts to publicize and promote the CHIP program through outreach and education efforts. As part of these initiatives, efforts have been made to portray CHIP as a form of health insurance rather than a welfare benefit. A slight paradox results where key actors, in the health and human services bureaucracy play an active role in program management while making efforts to dissassociate the program from the traditional welfare system. These efforts have been largely successful. And in doing so, not only have children been brought into the CHIP program but more families have been connected to the Medicaid program. In short, a review of state experiences reveals the resiliency and flexibility of existing state administiative systems in responding to and addressing substantive policy change.
From “Taxed” Health to Excise Tax: Ethical Accountability and the Fight for Comprehensive Tobacco Control Programson the National and State Levels
Authors: Wigfall Patricia M.
Published: May 2024

Government needs to take an ethical stand on the issue of tobacco control, thereby falling in line with the public administrators, public health advocates, and other public servants who support the passage of excise tax legislation and local ordinances that go beyond state preemption clean indoor air policy. That the excise tax will generate medical and economic benefits is unquestionable. In a similar vein, stronger local smoking bans to reduce levels of environmental tobacco smoke (ETS) will undoubtedly carry significant import for healthier work and leisure environments. What remains dubious is the degree to which the public can count on government support of anti-tobacco initiatives. A theory of administrative accountability is a significant part of assessing an issue that has ethical as well as medical and economic ramifications. This paper outlines the historical and current challenges facing public servants as they wager public health for regional economy.
Behavioral Anchors: Building a Medical Center on Solid Foundations
Authors: Doordan Martin L. , Stupak Ronald J.
Published: May 2024

Construction of new facilities in the healthcare arena is an ongoing, almost daily, occurrence. The desire to build wisely and effectively is evidenced at the Anne Arundel Medical Center which has attracted healthcare executives from all over the country who come to view, analyze, and experience the beauty, utility and interdependencies of the buildings and facilities that constitute “the AAMC campus.”

However, too often these executive visitors and benchmarking experts tend to focus on the technical, architectural, engineering, concrete aspects of the hospital, while naively overlooking and/or giving short shrift to the more critical behavioral dynamics of the construction process.

The ultimate success of any building project requires a clear understanding by the leadership of “where people are coming from,” so that both the design and the development of the final product can be brought under the synthesizing umbrella of patient care, clinical excellence, individual safety, and community responsibility.

Not only must the leadership determine and drive the strategic thrust toward the final outcome; in addition, they must make sure that they allow significant colleagues to be actively, operationally, and symbolically engaged in a process that ends up in a structural outcome that everyone is proud to own, to see, and to inhabit.
The Effects of Case Mix on Hospital Costs and Revenues in Managed Care Environments
Authors: Lee Keon-Hyung , Melnick Glenn A. , Myrtle Robert C.
Published: May 2024

Due to competition and managed care, hospitals have argued that the rate of increase in hospital cost is greater than the rate of increase in hospital revenue. It is important to pay hospitals based on the expected resource use of patients that hospitals treat. However, managed care organizations pay hospitals based on negotiated prices that do not consider the expected resource use of patients. The purpose of this paper is to provide a better understanding of those factors affecting hospital cost and revenue in California using the hospital financial and utilization data for selected years from 1986 to 1998. By developing case mix indexes (CMIs) using all hospital discharges in California, this study found that the coefficients for CMIs in total and inpatient hospital revenue models were greater than those in hospital cost models. Over time, however, the differences in coefficients for CMIs in hospital revenue and cost models become smaller and smaller. Thus, this study shows that the difference between hospital revenues and hospital costs, looking at hospital case mix, has decreased, although hospital revenues are still greater than hospital costs.
Evaluating Public Relations Effectiveness in a Health Care Setting
Authors: Henderson Julie K.
Published: May 2024

The practice of public relations has experienced tremendous growth and evolution over the past 25 years, especially in the area of medical public relations. The constant changes in health care delivery have often led to increased need for communication with important publics. At the same time, practitioners in all fields of public relations have explored methods of accurately measuring the effectiveness of public relations programs. One such method of evaluation is the communication audit. This paper includes a brief overview of the communication audit concept followed by a case study based on an audit conducted for a small, multicultural non-profit health-care agency. Steps taken to conduct the audit and the methodology used are discussed. An analysis of the data is used to address two research questions regarding the efficacy of the Center's mission and vision. Suggestions for future audits are provided.
Hospital Choice by Rural Medicare Beneficiaries: Does Hospital Ownership Matter? – A Colorado Case
Authors: Roh Chul-Young , Lee Keon-Hyung
Published: May 2024

About 45 percent of rural patients in Colorado bypassed their local rural hospitals during the 1990s. The effect of this phenomenon is a reduction in occupancy rates and a decrease in the competitiveness of rural hospitals, thereby ultimately causing rural hospitals to close and adversely affecting the communities that they were designed to serve. This study tests whether hospital ownership affects hospital choice by patients after controlling for institutional and individual dimensions. A conditional logistic regression is used to analyze Colorado Inpatient Discharge Data (CIDD) on 85,529 patients in addition to hospital data. Rural Medicare beneficiaries are influenced to choose a particular hospital by a combination of hospital characteristics (the number of beds, the number of services, accreditation, ownership type, and distance from patient residence) and patient characteristics (medical condition, age, gender, race, and total charge for services). Increasing rural hospitals’ survivability, collaborating with other rural hospitals, expanding the number of available services, making strategic alliance with other providers are possible strategies that may help ward off encroachment by urban competitors.
Barriers to Entrepreneurship in Healthcare Organizations
Authors: Phillips Frank S. , Garman Andrew N.
Published: May 2024

Entrepreneurship has received little attention in the healthcare industry, perhaps in part because of barriers inherent in the structure and culture of healthcare organizations. Eliminating barriers can help promote entrepreneurial activities to drive continuing innovation and identify new sources of revenue.
Measuring Costs of Child Abuse and Neglect: A Mathematic Model of Specific Cost Estimations
Authors: Conrad Cynthia
Published: May 2024

Few empirical facts exist regarding the actual costs of child abuse in the United States. Consistent data is not available for national or even statewide analysis. Clearly there is a need for such accounting in order to fully understand the damage created by child abuse and neglect. Policy makers and social welfare planners should take child abuse costs into consideration when determining expenditures for prevention and intervention programs. The real savings may far outweigh the costs of such programs when both direct and indirect costs of child abuse and neglect enter into the analysis.

This paper offers a model in which the actual costs of child abuse and neglect, based on direct, indirect, and opportunity costs associated with each case. Direct costs are those associated with the treatment of abused and neglected children as well as the costs of family intervention programs or foster care. Indirect costs are costs to society created by the negative effects of child abuse and neglect evinced by individuals who suffer such abuse and then as teens or adults engage in criminal behavior. Indirect costs also derive from the long term and ongoing health care needs required by victims of abuse, for both physical and mental health disorders. With the existence of this model, the author hopes to stimulate the discussion and desire for better data collection and analysis.

In order to demonstrate the utility of the model, the author has included some cost estimates from the Connecticut State Department of Children and Families and the works of other scholars looking into the question of costs for child abuse and neglect. This data represents the best available at this time. As a result, the model appearing here is specific to Connecticut. Even so, once more valid data becomes available, the model's structure and theoretical framework should adapt to the needs of other states to facilitate better measurement of relevant costs and provide a clearer picture of the utility of investment in the prevention and treatment of child abuse and neglect.
Burnout and Psychological Stress among Deans of Colleges of Medicine: A National Study
Authors: Mirvis David M. , Graney Marshall J. , Ingram Leslie , Tang Jun , Kilpatrick Anne Osborne
Published: May 2024

Psychological burnout may inhibit the ability of deans of colleges of medicine to effectively lead their organizations during periods of rapid change. The objective of this study was measure the prevalence and intensity of the psychological components of burnout and their correlates among deans of U.S. colleges of medicine. To do so, questionnaires that burnout, job stressors, personal support systems and job satisfaction were sent to deans of all U. S. colleges of medicine, and selected deans of nursing schools, and other academic health center leaders. Medical school deans exhibited a high prevalence of depersonalization (42.9% of respondents), emotional exhaustion (25.4%), and reduced personal accomplishment (27.0%). High levels of these subdomains and of overall burnout intensity significantly correlated with high levels of personal, job, and environmental stress; low levels of support or coping resources; high prevalence of physical and behavioral symptoms; and reduced job satisfaction. Deans of colleges of medicine frequently exhibit characteristics of burnout that may impede effective leadership. These characteristics are likely to intensify unless specific interventions are devised and implemented.
Managing Meaning for Strategic Change: The Role of Perception and Meaning Congruence
Authors: Scroggins Wesley A.
Published: May 2024

This paper is a qualitative study of the cultural and strategic changes being made by a mid-sized hospital in the southwestern United States. The purpose of the paper is twofold. First, the paper examines the methods used by strategic managers in this hospital to manage meaning and create congruent interpretations of culture and strategy throughout the organization. This paper takes a social construction, interpretive position that culture and strategy are created through human interaction and involve shared meaning systems and interpretive schemes that individuals use to interpret and make sense of their world. Second, the study examines the effectiveness of the methods used by hospital management by examining perceptual similarities and differences among top leadership and other organizational members. This paper takes the position that perceptual and meaning congruence are necessary for the successful implementation of strategy that is given in a top-down fashion.
Caregiver Burden, Elder Abuse and Alzheimer's Disease: Testing the Relationship
Authors: Gainey Randy R. , Payne Brian K.
Published: May 2024

Caregiver burden is among the most cited explanations for elder abuse in the literature. Despite its popularity, the explanation is rarely tested empirically. To fill this void in the literature, this study considers the role of caregiver burden in 751 suspected cases of elder abuse. The results suggest that the role of burden has been misstated in past research. Implications are provided.
Faith-Based versus Secular Providers of Social Services -Differences in What, How, and Where
Authors: Graddy Elizabeth A. , Ye Ke
Published: May 2024

Recent public policies have promoted an increased role for faith-based organizations in the delivery of publicly supported services. Yet, there is little information on how service delivery by faith-based and secular providers might differ. This study seeks a better understanding of role differences by analyzing the broad context of social service delivery patterns in Los Angeles County. We find important differences. Faith-based organizations are much more concentrated in their service offerings than their secular counterparts. However, they play an important role through their emphasis on transitional assistance, their multi-service orientation, and their reliance on interventions that utilize their unique strengths. Secular nonprofit and public providers, in contrast, offer a much more comprehensive set of services. The results suggest that faith-based organizations have a modest and focused role in social service delivery, but one that is complementary to the efforts of secular providers.
Is Fun for Everyone? Personality Differences in Healthcare Providers’ Attitudes toward Fun
Authors: Karl Katherine A. , Peluchette Joy V. , Harland Lynn
Published: May 2024

This study examines the role of personality (the Big Five dimensions) in attitudes towards fun and levels of experienced fun in the healthcare environment. Our results show that extraversion and agreeableness were positively related to attitudes toward fun. Extraversion and emotional stability (low neuroticism) were positively related to the level of experienced fun. In general, our sample expressed positive attitudes regarding the appropriateness, salience, and consequences of having fun at work. Additionally, those who reported experiencing greater levels of workplace fun had significantly lower emotional exhaustion and emotional dissonance, as well as higher job satisfaction. Implications for healthcare institutions are discussed.
The Effectl of Insurance Type on Prescription Drug Use and Expenditures among Elderly Medicare Beneficiaries
Authors: Saleh Shadi S , Weller Wendy , Hannan Edward
Published: May 2024

The debate over the impact of the new Medicare prescription drug benefit (Part D) has intensified in anticipation of its implementation. This paper contributes additional information related to the effect of different types of prescription drug coverage plans on use and expenditures among elderly Medicare beneficiaries. Crosssectional design using data from the 2002 Medical Expenditures Panel Survey (MEPS). The two dependent variables were (1) prescription drug use and (2) expenditures. The main independent variable was the type of drug insurance (Medicare FFS only [no Rx insurance], Medicare FFS + Rx insurance and Medicare HMO). Bivariate and multivariate analyses were used to test the effect of insurance type, and beneficiaries’ characteristics, on likelihood and level of drug use, as well as expenditures. The findings showed that average total drug expenditures among Medicare FFS enrollees who had Rx insurance (non-HMO) were higher ($182.51) than that of Medicare FFS enrollees with no Rx insurance. In addition, the former group had a higher likelihood (any use) of using prescribed medications. On the other hand, no differences in the likelihood of use were detected between Medicare HMO and Medicare FFS (no Rx insurance) enrollees. However, Medicare HMO enrollees had a higher level of drug use. In conclusion, The differences in drug use and expenditures by insurance type imply that each party (Medicare, Medicare Advantage plans, employers) will have a different set of dis/incentives for involvement in Medicare Part D.
Racial and Ethnic Disparities in the Financial Burden of Prescription Drugs among Older Americans
Authors: Xu K. Tom , Borders Tyrone F.
Published: May 2024

This study examines racial and ethnic disparities in the financial burden of prescription drugs among older Americans using a market and an egalitarian model. A nationally representative data set, the Medical Expenditure Panel Survey 2002, was used. The financial burden of prescription drugs was measured by the out-of-pocket expenditure and proportion. In the market model (utilization adjustment)., utilization was measured at the annual aggregate level by the total number of prescription drugs, the average refills and the average quantity per prescription drug. In the egalitarian model (need adjustment)., health was measured by 15 chronic and costly diseases and the SF-12. Individuals 65 years or older were included. Nationally representative estimates were calculated. Raw racial and ethnic disparities were observed in the bivariate analyses between non-Hispanic whites and Hispanics in the out-of-pocket expenditure and proportion, and between non-Hispanic whites and non-Hispanic blacks in the out-of-pocket proportion. However, these disparities disappeared after controlling for utilization or health needs. Insurance status contributed the most to the disparities in the financial burden of prescription drugs. In conclusion, The disparities in the financial burden of prescription drugs between non-Hispanic elderly whites and Hispanics may be attributable to differences in utilization patterns. However, whether health disparities contribute to disparities in the financial burden of prescription drugs requires studies of specific diseases.
Health as An Economic Engine: Evidence for the Importance of Health in Economic Development
Authors: Mirvis David M. , Chang Cyril F. , Cosby Arthur
Published: May 2024

Most discussions on the relationships between health and economic conditions have focused on the impact of differences in personal finances or national economic conditions on health. Recently, however, the role of health as an ‘economic engine’ has been promoted. This paradigm proposes that better health leads to economic development. Evidence from historical, national, and transnational studies have shown that improved health increases economic growth through impacts on micro- and macro-economic factors. In this review, we will summarize the evidence supporting these concepts as a basis for discussing their implications for underdeveloped regions within the United States.
Establishing Values-Based Leadership and Value Systems in Healthcare Organizations
Authors: Graber David R. , Kilpatrick Anne Osborne
Published: May 2024

The importance of values in organizations is often discussed in management literature. Possessing strong or inspiring values is increasingly considered to be a key quality of successful leaders. Another common theme is that organizational values contribute to the culture and ultimate success of organizations. These conceptions or expectations are clearly applicable to healthcare organizations in the United States. However, healthcare organizations have unique structures and are subject to societal expectations that must be accommodated within an organizational values system.

This article describes theoretical literature on organizational values. Cultural and religious influences on Americans and how they may influence expectations from healthcare providers are discussed. Organizational cultures and the training and socialization of the numerous professional groups in healthcare also add to the considerable heterogeneity of value systems within healthcare organizations. These contribute to another challenge confronting healthcare managers -competing or conflicting values within a unit or the entire organization.

Organizations often fail to reward members who uphold or enact the organization's values, which can lead to lack of motivation and commitment to the organization. Four key elements of values-based leadership are presented for healthcare managers who seek to develop as values-based leaders. 1) Recognize your personal and professional values, 2) Determine what you expect from the larger organization and what you can implement within your sphere of influence, 3) Understand and incorporate the values of internal stakeholders, and 4) Commit to values-based leadership.
Mental Health Services Availability and Admission of the Seriously Mentally Ill from the Emergency Department
Authors: Moseley Charles , Shen Jay , Cochran Christopher
Published: May 2024

This study used a cross-sectional, multiple logistic regression design to examine the relationship between mental health service availability and the admission of 111,527 seriously mentally ill (SMI) patients from the emergency department (ED) in New York State in 2002. The study found that SMI patients were admitted from the ED in counties that were mental health professional shortage areas and in counties with less long-term inpatient psychiatric days. Contrary to expectations, counties with community mental health centers (CMHCs) had more admissions than counties without CMHCs. The results support prior research that indicates the need for more specialized mental health services for the SMI, including more psychiatric beds.
Humanism in Nursing Homes: The Impact of Top Management
Authors: Castle Nicholas G. , Ferguson Jamie C. , Hughes Kevin
Published: May 2024

We provide a review of ways in which top managers of nursing homes can provide or impact the humanistic component of care provided in their facilities. We describe the nursing home top management team; the role of top managers in nursing homes; the role of top managers as leaders in the nursing home; the literature examining the impact of top managers in nursing homes; and, examine developments in the nursing home industry that are influencing (or could potentially influence) the humanistic components of care. We conclude with suggestions for top managers, nursing home owners, and policy makers to create more caring humanistic environments. Suggestions include resident-directed care initiatives and culture change.
The Health Care Leader as Humanist
Authors: Kilpatrick Anne Osborne
Published: May 2024

This paper discusses the nature of humanism in healthcare management and leadership. Humanism in healthcare management should entail serving 1) patients and their families, 2) organizational members, and 3) the community. The article describes how humanism is largely absent from healthcare organizations as a critical and important value. In the twentieth century, a number of models of healthcare leadership were developed that were humanistic in focus. These models primarily stressed the value of attention by leaders on the needs and values of people working in the organization. However, humanistic, healthcare leadership involves not only motivating and empowering employees, but a primary, essential focus is for leaders to create environments that support and uplift patients and their families. Humanistic care in healthcare organizations can be facilitated by leaders establishing positive, supportive, and empowering environments for clinicians and other employees. Secondly, managers can establish programs to develop and train employees to provide humanistic care.
The Effects of Involvement and Ad Type on Attitudes toward Direct-To-Consumer Advertising of Prescription Drugs
Authors: Limbu Yam , Torres Ivonne M.
Published: May 2024

This article examines consumers’ attitudes toward Direct-to-Consumer (DTC) advertising of prescription drugs that are influenced by the use different types of DTC ads and product involvement. Our findings suggest that product involvement and the type of DTC ad are significant predictors of consumers’ attitudinal responses toward DTC advertising. High involvement consumers have more favorable attitudes toward the drug's price, DTC ad and brand name, and a higher intention to ask a doctor about the advertised drug than low involvement consumers. In contrast to Informational and Reminder DTC ads, Persuasive ads have more favorable effects on consumers’ reactions to DTC prescription drug advertising.
Drug Treatment Program Compliance and Resistance Activities during Implementation of California'S Proposition 36
Authors: Reynolds Grace
Published: May 2024

The Substance Abuse and Crime Prevention Act (SACPA), also known as Proposition 36, was implemented statewide in 2001 in California. This legislation remands non-violent drug offenders to drug treatment rather than prison or jail.

Structured telephone interviews were conducted with a purposive sample of 72 drug treatment programs from six Southern California counties concerning compliance and resistance activities during implementation. A linear regression model was developed that used a dependent variable capturing overall experience with Proposition 36 and compliance and resistance activities as independent variables. The final model included three compliance variables (sharing problems and solutions with other treatment providers, hiring new staff, acquiring additional space through rental or purchase) that were most predictive of the programs’ overall experience with Proposition 36. The implications of these findings in the context of organizational compliance and resistance activities are discussed.
Knowledge, Behaviour, Perceptions and Attitudes of University of Ghana Students towards Hiv/Aids: What Does Behavioural Surveillance Survey Tell Us?
Authors: Tagoe Michael , Aggor R.A.
Published: May 2024

This study assesses knowledge, attitudes and behaviour in respect of risk of HIV infection of students through behavioral surveillance survey. The study used the systematic sampling approach to select 375 students. Interviews and focus group discussions were conducted to solicit information from respondents. The study found out that the students engaged in pre-marital sex, although this was more common among the male than female students. Students did not use condoms consistently and were not likely to use condoms when the relationship was considered as stable because of trust. Students revealed that they were all at risk of infection; however, a significant number of them did not know their HIV status and were not ready to take the test for fear of stigmatization. There low level knowledge among female students of the different types of STI. The results suggest that there is need for an appropriate education program for students. Peer education clubs need to be established to provide education on condom management. In addition, edutainment-education through entertainment program on HIV/AIDS - needs to be an integral part of the university's curriculum. More recreational centers need to be established to allow students to channel their energies towards sports.
Medicaid Fee for Service Reimbursement and the Delivery of Human Services for Individuals with Developmental Disabilities Or Severe Mental Illness: Negotiating Cost
Authors: Walker Melissa A. , Osterhaus Jason E.
Published: May 2024

Fees paid by Medicaid are a primary resource for nonprofit organizations serving individuals with developmental disabilities and severe mental illness. While Medicaid reimbursement has facilitated the transition from institutional to community care, cost is not well understood. This article examines how government and nonprofit organizations negotiate the cost of service delivery. Analysis based on this case study shows cost is a central concern for both government and nonprofit service providers.
The Importance of Performance Assessment in Local Government Decisions to Fund Health and Human Services Nonprofit Organizations
Authors: Vaughan Shannon K.
Published: May 2024

In times of fiscal crisis, demand for health and human services increases while revenues shrink, causing funders to focus more intently on identifying the most successful organizations in which to invest scarce resources. This research grew out of interest in enhancing performance assessment of nonprofit organizations expressed by local government managers. A survey of Alliance for Innovation Members explores two primary research questions: 1) what is a successful nonprofit; and 2) what type(s) of performance assessment tools are the most useful. The results strengthen our understanding of what information city and county managers want and why they prefer certain evaluation tools.
Illness Onset as Status Passage for People with Multiple Sclerosis (Ms)
Authors: Vickers Margaret H.
Published: May 2024

The lived experience of the Illness Onset Status Passage for people with Multiple Sclerosis (MS) is explored here. Glaser and Strauss’ (1971) status passage is used to analyse the properties of this Status Passage. The Illness Onset Status Passage for people with MS includes three key phases: (1) An Unknown Passage lived as either what are thought to be “Harmless” Symptoms or, conversely, as Alarming Symptoms, both of which are experienced without knowledge of having MS; (2) Incomplete Knowledge (ie accompanying initial diagnosis) Lived as Felt Stigma arising as a result of the person's own lack of useful knowledge of the disease at the point of diagnosis, and compounded by negative community stereotypes about MS; and, (3) Living Thrownness, where the person with MS is thrown into turmoil and ill equipped to deal with their changed life. While it is acknowledged that the life journey for people with MS will contain multiple status passages, this initial status passage – the Illness Onset Status Passage – needs to be better understood so that people with MS get the support that they need from health care professionals and others at such a critical time in their lives.