Funding the utilization of community health workers in Texas

Community health workers (CHWs) are volunteers or paid members of communities that perform outreach, patient assistance, health education, and assist in navigation of healthcare system amongst other duties. The utilization of CHWs in hospital and community setting provides health benefits to their communities while reducing cost to the overall healthcare system. ^ The general population of Texas lacks adequate access to primary care. An important indicator of such a crisis is excessive usage of emergency department services in Texas, especially by the large minority population within the state. Also, unmanaged chronic diseases have been shown to be correlated with the excessive usage of emergency services. According to a recent survey of 25 Houston metropolitan area hospitals, almost 54% of the ER visits could have been resolved in primary care settings. A Galveston based study also indicated that the ER usage was higher amongst African-Americans and Latinos. Meanwhile, 28.5% of the total ER visits were made by Latinos from the surrounding areas (Begley et al., 2007). There is substantial evidence present which indicates enormous cost-savings that CHWs have produced in Texas and nationwide through reduction in unnecessary ER visits along with better management of chronic diseases (Fedder et al, 2003). ^ This paper provides an analysis regarding the need and importance for sustainable and stable sources of funding for Community health workers (CHWs) in Texas utilizing Kingdon's model of Agenda Setting as framework. The policy analysis is also aimed at reporting on the policy process and actions taken by Children at Risk to address this critical issue. Children at Risk, a Houston based advocacy organization, has created a legislative proposal that calls on the Texas Health and Human Commission to apply for a Medicaid §§1115 waiver to provide sustainable sources of funding for CHWs, Rep. John Zerwas sponsored HB 2244 bill and it was filed on March 3, 2011. The bill would affect the use of CHWs in Texas in two ways: 1) through the establishment and operation of a program designed to train and educate CHWs 2) by creating a statewide training and certification advisory committee. The advisory committee is required in the bill to submit recommendations for providing sustainable funding and employment for CHWs. The HB 2244 failed to move out of the House Public Health committee. However, HB2244 was amended into HB 2610 introduced by Representative Guillen. The House Bill 2610 is geared towards establishing a community-based navigator program in order to assist individuals applying for public assistance through the Internet. The House Bill 2610 was signed by the Governor and will be effective September 1, 2011.^

Should Texas use public funding for bariatric surgery?

Background. Obesity in America has increased exponentially since the 1970s with no sign of slowing down. It is a major public health problem, and is currently the second leading cause of preventable deaths in America (Flegal et al., 2010). Bariatric surgery is currently the only approved therapy that has shown to have a lasting impact on obese patients. While the initial cost of the surgery remains high, numerous cost-benefit analyses have demonstrated an overall cost saving within two to five years (McEwen et al., 2010). Only three states, including Texas, do not currently fund bariatric surgery through Medicare and Medicaid. ^ Objectives. To determine whether the current data on the cost-benefit analysis of bariatric surgery supports Texas' decision to not publicly fund bariatric surgery through its Medicare and Medicaid programs. ^ Methods. We conducted literature reviews to determine the current cost of obesity in Texas as well as the methods being employed to treat obesity currently. We then analyzed the history of bariatric surgery and its current implementation, looking at safety and the future benefits of bariatric surgery. We then looked at key cost-benefit analyses and meta-analyses to determine the cost effectiveness of bariatric surgery. We then analyzed both direct medical expenditures and indirect benefits of bariatric surgery. ^ Conclusions. If the obesity epidemic continues unabated, it will become one of the leading health expenditures in Texas within decades. Given that surgery is currently the only approved therapy for obesity that has been shown to be effective in the majority of patients, Texas' decision not to publicly fund bariatric surgery is short sighted.^

Abortion Funding: a Matter of Justice

Ibis Reproductive Health

It's confusing when the Swiss go to the polls. Here are 6 surprising things about their elections

On Sunday, Switzerland votes on its federal parliament. The members of both chambers - 200 National Councillors and 46 Councillors of States - are directly elected, with the 26 Swiss cantons (or provinces) forming the districts. Seats in the National Council are distributed to the cantons based on their population size, while in the Council of States each full canton gets two seats and the six half-cantons get one each. Here are six things to look out for.

The 2015 Swiss elections: A landslide win for the right, despite limited changes in vote share

Switzerland held federal elections on 18 October, with the conservative Swiss People’s Party winning the largest share of the votes. Daniel Bochsler, Marlène Gerber and David Zumbach write that while the increase in vote share for the Swiss People’s Party was relatively limited, the party managed to significantly increase the number of seats it holds in Switzerland’s lower house of parliament, the National Council. Nevertheless, the party is unlikely to make substantial gains in the country’s upper house, the Senate, as it traditionally struggles under the two-round electoral system used in Senate elections.

Political conditions for fair elections

Democracy is not necessarily consolidated simply by the introduction of formal democratic institutions. It is often observed in new democracies that democratic institutions are neglected and eroded in actual practice. Particularly, electoral fraud committed by a ruler is one of the main problems in this regard. This paper deals with two questions, (1) under what conditions does a ruler have an incentive to hold fair elections (or to rig elections), and (2) what makes a ruler prefer to establish an independent election governing institution? Assuming that a ruler prefers to maintain her power, basically she has an incentive to rig elections in order to be victorious in the political competition. A ruler, however, faces the risk of losing power if the opposition stages successful protests on a sufficiently large scale. If opponents are able to pose a credible threat to a ruler, she will have an incentive to hold fair elections. The problem is that information on electoral fraud is not shared by every player in the game. For the opposition, imperfect information deepens their coordination problems. Imperfect information, on the other hand, in some cases causes a problem for a ruler. If the opposition is sufficiently cohesive and have little tolerance of cheating, even unverified suspicions of fraud may trigger menacing protests. In such a case, a ruler has an incentive to establish an independent election commission to avoid unnecessary collisions by revealing the nature of the elections.

Ethnicity and Elections under Authoritarianism: The Case of Kazakhstan

Despite the ethnicisation of power since independence in 1991, Kazakhstan has managed to maintain political stability without experiencing large-scale mobilisation to oppose Kazakh domination. This paper examines government strategy to avoid ethnic voting in an attempt to explain why ethnic divisions were rarely reflected in the struggle for power in the republic. While the arbitrary use of legal provisions considerably limited participation in elections by ethnic leaders, powerful pro-president parties that exhibited a cross-ethnic character were created to curtail ethnically based movements. The control strategy in elections aimed not simply at ethnicising the parliament in favour of Kazakhs, but at having loyal Russians and other minorities represented in the legislature through nomination by the president and catch-all pro-regime parties, or through the presidential consultative body—Assembly of the People of Kazakhstan. This well-controlled representation of minorities served not only to placate non-Kazakhs but also to provide legitimacy for the Kazakh-dominated leadership by projecting the image of cross-ethnic support for the president and some degree of power-sharing.

Changing local elite selection in Thailand : emergence of new local government presidents after direct elections and their capabilities

Before rural local government units were established in Thailand, reform debates within the country faced a crucial issue: Candidates at the rural sub-district levels might adopt electioneering methods such as vote buying and the patronage system of the local political and economic elite, the methods that had been used in the national elections. In fact, the results of the 2006 survey in this paper, which followed the introduction of direct elections in rural local government units in 2003, contrast with the result anticipated during the debates on political reform. The preliminary data of the survey shows that the decentralization process and the introduction of the direct election system in the rural areas had some effect in changing the selection process of the local elite in Thailand.

Elections, information aggregation, and strategic voting

A central role of elections is the aggregation of information dispersed within a population. This article surveys recent work on elections as mechanisms for aggregating information and on the incentives for voters to vote strategically in such elections.

The Research Funding Service: a model for expanded library services

Traditionally, libraries have provided a modest amount of information about grants and funding opportunities to researchers in need of research funding. Ten years ago, the University of Washington (UW) Health Sciences Libraries and Information Center joined in a cooperative effort with the School of Medicine to develop a complete, library-based grant and funding service for health sciences researchers called the Research Funding Service. The library provided space, access to the library collection, equipment, and electronic resources, and the School of Medicine funded staff and operations. The range of services now includes individual consultation appointments, an extensive Web site, classes on funding database searching and writing grant applications, a discussion series that frequently hosts guest speakers, a monthly newsletter with funding opportunities of interest to the six health sciences schools, extensive files on funding sources, and referral services.