Policy analysis of shifting to the state-run Texas women's health program

During the 82nd Texas legislature, state leaders passed a provision stating that healthcare providers, who perform, promote, or affiliate with providers who perform or promote elective abortion services may not be eligible to participate in the Texas Medicaid Women's Health Program (WHP). The federal government reacted to this new provision by vowing to eliminate its 90% share of program support on the grounds that the provision violated a patient's freedom to choose a provider; a right protected by the Social Security Act. Texas leaders stated that the Women's Health Program would continue without federal support, financed exclusively with state funds.^ The following policy analysis compares the projected impact of the current Medicaid Women's Health Program to the proposed state-run program using the criteria-alternative matrix framework. The criteria used to evaluate the program alternatives include population affected, unintended pregnancy and abortion impact, impact on cervical cancer rate, and state-level government expenditures. Each criterion was defined by selected measures. The population affected was measured by the number of women served in the programs. Government expenditures were measured in terms of payments for program costs, Medicaid delivery costs, and cervical cancer diagnostic costs. Unintended pregnancy impact was measured by the number of projected unplanned pregnancies and abortions under each alternative. The impact on cervical cancer was projected in terms of the number of new cervical cancer cases under each alternative. Differences in the projections with respect to each criterion were compared to assess the impact of shifting to the state-only policy.^ After examining program alternatives, it is highly recommended that Texas retain the Medicaid WHP. If the state does decide to move forward with the state-run WHP, it is recommended that the program run at its previous capacity. Furthermore, for the purpose of addressing the relatively high cervical cancer incidence rate in Texas, incorporating HPV vaccination coverage for women ages 18-26 as part of the Women's Health Program is recommended.^

The cost of insuring the uninsured in the U.S.

Objectives: This study included two overarching objectives. Through a systematic review of the literature published between 1990 and 2012, the first objective aimed to assess whether insuring the uninsured would result in higher costs compared to insuring the currently insured. Studies that quantified the actual costs associated with insuring the uninsured in the U.S. were included. Based upon 2009 data from the Medical Expenditure Panel Survey (MEPS), the second objective aimed to assess and compare the self-reported health of populations with four different insurance statuses. The second part of this study involved a secondary data analysis of both currently insured and currently uninsured individuals who participated in the MEPS in 2009. The null hypothesis was that there were no differences across the four categories of health insurance status for self-reported health status and healthcare service use. The alternative hypothesis was that were differences across the four categories of health insurance status for self-reported health status and healthcare service use. Methods: For the systematic review, three databases were searched using search terms to identify studies that actually quantified the cost of insuring the uninsured. Thirteen studies were selected, discussed, and summarized in tables. For the secondary data analysis of MEPS data, this study compared four categories of health insurance status: (1) currently uninsured persons who will become eligible for Medicaid under the Patient Protection and Affordable Care Act (PPACA) healthcare reforms in 2014; (2) currently uninsured persons who will be required to buy private insurance through the PPACA health insurance exchanges in 2014; (3) persons currently insured under Medicaid or SCHIP; and (4) persons currently insured with private insurance. The four categories were compared on the basis of demographic information, health status information, and health conditions with relatively high prevalence. Chi-square tests were run to determine if there were differences between the four groups in regard to health insurance status and health status. With some exceptions, the two currently insured groups had worse self-reported health status compared to the two currently uninsured groups. Results: The thirteen studies that met the inclusion criteria for the systematic review included: (1) three cost studies from 1993, 1995, and 1997; (2) four cost studies from 2001, 2003, and 2004; (3) one study of disabilities and one study of immigrants; (4) two state specific studies of uninsured status; and (5) two current studies of healthcare reform. Of the thirteen studies reviewed, four directly addressed the study question about whether insuring the uninsured was more or less expensive than insuring the currently insured. All four of the studies provided support for the study finding that the cost of insuring the uninsured would generally not be higher than insuring those already insured. One study indicated that the cost of insuring the uninsured would be less expensive than insuring the population currently covered by Medicaid, but more expensive to insure than the populations of those covered by employer-sponsored insurance and non-group private insurance. While the nine other studies included in the systematic review discussed the costs associated with insuring the uninsured population, they did not directly compare the costs of insuring the uninsured population with the costs associated with insuring the currently insured population. For the MEPS secondary data analysis, the results of the chi-square tests indicated that there were differences in the distribution of disease status by health insurance status. As anticipated, with some exceptions, the uninsured reported lower rates of disease and healthcare service use. However, for the variable attention deficit disorder, the uninsured reported higher disease rates than the two insured groups. Additionally, for the variables high blood pressure, high cholesterol, and joint pain, the currently insured under Medicaid or SCHIP group reported a lower rate of disease than the two currently insured groups. This result may be due to the lower mean age of the currently insured under Medicaid or SCHIP group. Conclusion: Based on this study, with some exceptions, the costs for insuring the uninsured should not exceed healthcare-related costs for insuring the currently uninsured. The results of the systematic review indicated that the U.S. is already paying some of the costs associated with insuring the uninsured. PPACA will expand health insurance coverage to millions of Americans who are currently uninsured, as the individual mandate and insurance market reforms will require. Because many of the currently uninsured are relatively healthy young persons, the costs associated with expanding insurance coverage to the uninsured are anticipated to be relatively modest. However, for the purposes of construing these results, it is important to note that once individuals obtain insurance, it is anticipated that they will use more healthcare services, which will increase costs. (Abstract shortened by UMI.)^

Strange bedfellows: The ethics and politics of medical futility in Texas

Background: Futile medical treatments are interventions that are not associated with a benefit to the patient. The definition and concept of medical futility are controversial. The Texas Advance Directives Act (TADA) was passed in 1999 to address medically inappropriate interventions by allowing providers to withdraw inappropriate interventions against a surrogate decision maker's wishes following a review, attempt to transfer the patient, and 10-day waiting period. The original legislation was a negotiated compromise by players across the political spectrum. However, in recent years there has been increasing controversy regarding TADA and attempts to alter its applicability in Texas. ^ Purpose: The purpose of this project was to apply Paul Sabatier's advocacy coalition framework (ACF) to gain understanding into the historical, ethical, and political basis of the initial compromise, and determine the sources of conflict that have led to increased opposition to TADA. ^ Methods: Using the ACF model, key actors within the medical futility policy debate in Texas were aggregated into coalitions based on shared beliefs. A narrative summary based analysis identified the core elements of the policy subsystem, as well as the constraints and resources of the subsystem actors. Externalities that promoted adjustments to coalition beliefs and tactics used by coalition participants were analyzed. Data sources included review of the published literature regarding medical futility, as well as analysis of published newspaper accounts and editorials regarding the medical futility issue in Texas, legislative testimony, and review of weblogs and online commentaries dealing with the issue. ^ Results: Primary coalition participants in developing compromise legislation in 1999 were the Providers and Vitalists, with Autonomists gaining a prominent role starting in 2006. Internal factors associated with the breakdown of consensus included changes to the makeup of the governing coalition and changes in individual case information available to the Vitalist coalition. Externalities related to the intertwining of the Sun Hudson case and the Terri Schiavo case generated negative publicity for the TADA from progressive and conservative viewpoints. Dissemination of information in various venues regarding contentious cases was associated with more polarization of viewpoints, and realignment of coalition alliances. ^ Conclusions: The ACF provided an outline for the initial compromise over the creation of the Texas Advance Directives Act as well as the eventual loss of consensus. The debate between the Provider, Vitalist, and Autonomist coalitions has been affected by internal policy evolution, changes in the governing coalition, and important externalities. The debate over medical futility in Texas has had much broader implications in the dispute over Health Care Reform.^

Student consumption of a la carte foods during school lunch meals

The purpose of this study was to evaluate students' lunch consumption compared to NSLP guidelines, the contribution of competitive foods to calorie intake at lunch, and the differences in nutrient and food group intake between the a la carte food consumers and non- a la carte food consumers.^ In Fall 2011, 1170 elementary and 440 intermediate students were observed anonymously during school lunch. The foods eaten, their source, grade level, and gender were recorded. All a la carte offerings met the Texas School Nutrition Policy.^ Differences in nutrient and food group intake by grade level and between students who consumed a la carte and those who did not were assessed using ANCOVA. A chi-squared analysis was conducted to evaluate differences in a la carte food consumption by grade level, gender, and the school's low income status.^ Average lunch intakes for elementary students were 457 (SD 164) calories for elementary students and 541 calories (SD 188) for intermediate students (p<0.001). 760 students (47%) consumed 937 a la carte foods, with the most often consumed items being chips (32%), ice cream (22%) and snack items (18%). Mean a la carte food intakes were 60 and 98 calories for elementary and intermediate schools respectively (p<0.001). Significantly more (p<0.000) intermediate students (34.3%) consumed a la carte items compared to elementary students (27.5%).^ Students who consumed a la carte foods had significantly higher intakes of calories (p<0.000), fat (p<0.000), sodium (p<0.002), fiber (p<0.000), added sugar (p<0.000), total grains (p<0.000), dessert foods (p<0.000), and snack chips (p<0.000) and lower intakes of vitamin A (p<0.001), iron (p<0.000), fruit (p<0.022), vegetables (p<0.031), milk (p<0.000), and juice (p<0.000) compared to students who did not eat a la carte foods.^ Although previous studies have found that reducing availability of unhealthy items at school decreased student consumption of these items, the results of this study indicate that even the strict guidelines set forth by the state of Texas are not sufficient to prevent increased caloric intake and poor nutrient intake. Strategies to improve student selection and consumption at school lunch when a la carte foods are available are warranted.^

Comparison of health behaviors of Mexican American and non -Hispanic White females: Implications for health promotion programs

Hispanics form the second-largest minority group in the United States totaling 22 million people. Health data on this population are sparse and inconsistent. This study seeks to determine use of preventative services and risk factor behaviors of Mexican American and non-Hispanic White females residing in South Texas.^ Baseline data from female respondents in household surveys in six South Texas counties (Ramirez and McAlister, 1988; McAlister et al., 1992) were analyzed to test the following hypotheses: (1) Mexican American and Non-Hispanic White females exhibit different patterns of health behaviors; (2) Mexican American females will exhibit different health behaviors regardless of age; and (3) the differences between Mexican American women and non-Hispanic White females are due to education and acculturation factors.^ Over the past decade, the traditional behaviors of Mexican American females have begun to change due to education, acculturation, and their participation in the labor force. The results from this study identify some of the changes that will require immediate attention from health care providers. Results revealed that regardless of ethnicity, age, education, and language preference, non-Hispanic White females were significantly more likely to participate in preventive screening practices than were Mexican American females. Risk factor analysis revealed a different pattern with Mexican American females significantly more likely to be non-smokers, non-alcoholic drinkers, and to have good fat avoidance practices compared to non-Hispanic White females. However, compared to those who are less-educated or Spanish-speaking, Mexican American females with higher levels of education and preference for speaking English only showed positive and negative health behaviors that were more similar to the non-Hispanic White females. The positive health behaviors that come with acculturation, e.g., more participation in preventive care and more physical activity, are welcome changes. But this study has implications for global health development and reinforces a need for "primordial" prevention strategies to deter the unwanted concomitants of economic development and acculturation. Smoking and drinking behaviors among Mexican American females need to be kept at low levels to prevent increased morbidity and premature deaths in this population. ^

Percepción parental de calidad de vida relacionada con la salud bucal en niños preescolares

Los estudios de calidad de vida no sólo son usados para evaluar resultados de programas preventivos y terapéuticos, sino también para acercar a la comunidad científica las percepciones sociales y personales de los individuos estudiados. Por ello el presente proyecto desarrolló un estudio correlacional, descriptivo y transversal con el objetivo de llegar a conclusiones válidas acerca de la relación entre la percepción parental del impacto en la calidad de vida de la población de niños estudiada, y su experiencia de caries expresada a través del índice ceod. Se elaboró un cuestionario para padres de niños preescolares con el objeto de valorar la percepción parental de la salud bucal en la calidad de vida de sus hijos, que incluye 18 preguntas unidas en cuatro grupos de dominio: síntomas orales, limitaciones funcionales, bienestar emocional y bienestar social. Del análisis de los porcentajes discriminados de las respuestas se puede inferir que la percepción parental con respecto a la calidad de vida en relación a la salud bucal de sus hijos está distorsionada. La mayor actividad de caries no es percibida por los padres como un problema o como una disminución de la calidad de vida en relación a la salud bucal de sus hijos.

La cultura en el desarrollo económico local : una aplicación en el Museo de Antioquia (Medellín , Colombia)

La cultura se presenta hoy como un elemento determinante en la planificación del desarrollo, tanto por los efectos económicos que genera en términos de empleo, ingresos, y producción; como por ser un instrumento útil y eficaz para el fortalecimiento de la independencia, la soberanía y la identidad de los territorios en un mundo globalizado. El objetivo de este estudio es reconocer el impacto de la cultura en el desarrollo económico a través de un ejercicio empírico centrado en el Museo de Antioquia de la ciudad de Medellín (Colombia). Se aplicó una encuesta de percepción a los habitantes y visitantes de la ciudad. Los datos se sometieron a un análisis descriptivo y se formalizó un Modelo de Regresión Logística en busca de identificar y explicar los elementos que permiten vincular la cultura y el desarrollo. Se encontró que cerca al 90% de los encuestados afirmaron que la existencia del Museo de Antioquia es importante para el desarrollo económico de la ciudad de Medellín, identificándolo como un atractivo turístico y cultural que genera impactos positivos en el crecimiento económico y el bienestar social.

Valoración económica de los efectos de la presión antrópica sobre el piedemonte mendocino : una aplicación de los experimentos de elección discreta

En general, el análisis socioeconómico de los sistemas naturales no se contempla en los dominios de la ciencia natural. En este trabajo, sin embargo, se estima el cambio en el bienestar social por los efectos de la presión antrópica sobre el piedemonte mendocino vía la menor provisión de servicios ambientales. Para ello, se utiliza el método de los experimentos de elección discreta para inferir el valor social de tres servicios ambientales generados en las cuencas ubicadas al oeste del Gran Mendoza (riesgo aluvional, cobertura vegetal y recreación) y los costos de programas diseñados para mitigar la intensidad de dichos efectos. Un incremento del riesgo aluvional es el efecto de origen antrópico sobre el piedemonte mendocino que más preocupa a la población, seguido de una disminución de la cobertura vegetal y de la recreación. Se estimó que un incremento del riesgo aluvional en 1% equivale en pérdida de bienestar individual a un gasto, en promedio, de 24,13 pesos, en moneda de 2013, al año, cifra que es equivalente en términos de bienestar a una disminución de 6% de cobertura vegetal. Esta información puede ayudar a los hacedores de políticas, gestores de territorio y ecologistas a tener en cuenta las preferencias sociales en el diseño de sus programas y actividades.

Healthy aging : Free time of adults

El trabajo que aquí se presenta surge de la necesidad de conceptualizar y profundizar sobre el uso productivo del tiempo libre de las personas adultas mayores. Se llevará a cabo una aproximación teórica sobre las diferentes concepciones de tiempo libre y ocio como dimensiones interdisciplinarias que involucran elementos referidos al entorno en donde personas y comunidades buscan integrarse en un tiempo y espacio determinado

Movimiento sindical y peronismo (1943-1955) : Hacia una nueva interpretación

El objetivo del artículo es aportar en la construcción de una nueva interpretación del vínculo movimiento sindical y peronismo. En pos de eso, se observan las posiciones gubernamentales en relación a la conflictividad obrera, la naturaleza de ésta, el poder sindical que la hacía posible; y, finalmente, el Congreso Nacional de la Productividad y el Bienestar Social de marzo de 1955. En base a lo anterior, se afirma que el gobierno peronista fracasó en su intento de frenar y controlar el conflicto social y que esto se debió, en gran medida, al poder político y social que ostentó el movimiento sindical

Hacia un enfoque analítico y de políticas para las interacciones entre ciencia, universidad y sociedad en la región latinoamericana

El objetivo de este trabajo es argumentar sobre la importancia del enfoque de redes de conocimiento, generado en el campo de los estudios sociales de la ciencia y la tecnología (CTS), para el análisis de las relaciones entre ciencia, universidad y sociedad. La construcción de procesos interactivos, cooperativos entre actores y el aprendizaje constituyen dimensiones clave para producir y utilizar conocimiento en la mejora del bienestar social de nuestras poblaciones. El trabajo expone brevemente las concepciones que han dominado en las políticas de ciencia y tecnología en la región latinoamericana; se argumenta sobre la importancia de los enfoques de redes de conocimiento y de la perspectiva regional y local al interior de los países, tanto para analizar la generación, intercambio y uso de conocimiento como para el diseño e implementación de políticas públicas de ciencia, tecnología e innovación; se documenta si en las nuevas concepciones de políticas de ciencia, tecnología e innovación en América Latina que destacan la importancia de la inclusión social se está adoptando el enfoque de redes de conocimiento y la perspectiva regional; y, se ofrecen, a manera de conclusiones, algunas argumentaciones sobre el futuro de las relaciones entre universidad y sociedad en lo que al desarrollo científico y tecnológico se refiere.

Identidad y decisiones políticas de jóvenes brasileños, argentinos y uruguayos

Basado en datos cuantitativos producidos por la investigación piloto "Jóvenes frente a la Historia", este texto analiza algunas características de la cultura política y conciencia histórica de jóvenes, especialmente relativas a sus referencias de identidad y actitudes políticas. Metodológicamente, el proyecto ha trabajado con cuestionario de escala Likert, aplicado a jóvenes de distintas regiones de Brasil, Argentina y Uruguay. Se discute el tema de la identidad y elecciones políticas en la contemporaneidad, y se analizan algunos de los resultados del cuestionario sobre esos temas. Los resultados demuestran el predominio de valores individuales o individualistas, matizados por algunas preocupaciones en la zona de confluencia entre lo personal y lo colectivo - es decir el bienestar social y la preservación de la naturaleza. El estudio también revela una tendencia general a posiciones menos marcadas, más próximas a la indiferencia o ausencia de opinión

Interferencias políticas e interinstitucionales al proyecto de centralización de la administración sanitaria nacional (1943-1945)

El objetivo de este trabajo es profundizar en las razones de los cambios que se operan en la estructura administrativa sanitaria nacional entre 1943 y 1945. Si bien la creación de la Dirección Nacional de Salud y Acción Social en 1943 responde a una larga demanda de los círculos académicos de centralización administrativa y de unificación de las funciones sanitarias y asistenciales, la corta duración del proyecto (menos de un año) expone consideraciones por afuera de la lógica administrativa. Analizamos aquellas que se vinculan con la complicada relación entre la repartición nacional con los gobiernos provinciales y las organizaciones de beneficencia, con la injerencia del gremialismo médico en el delineamiento de las políticas sanitarias y con el ascendiente de Juan Domingo Perón desde la Secretaría de Trabajo y Bienestar Social en la monopolización de la asistencia social como capital político.

Movimiento sindical y peronismo (1943-1955) : Hacia una nueva interpretación

El objetivo del artículo es aportar en la construcción de una nueva interpretación del vínculo movimiento sindical y peronismo. En pos de eso, se observan las posiciones gubernamentales en relación a la conflictividad obrera, la naturaleza de ésta, el poder sindical que la hacía posible; y, finalmente, el Congreso Nacional de la Productividad y el Bienestar Social de marzo de 1955. En base a lo anterior, se afirma que el gobierno peronista fracasó en su intento de frenar y controlar el conflicto social y que esto se debió, en gran medida, al poder político y social que ostentó el movimiento sindical

Hacia un enfoque analítico y de políticas para las interacciones entre ciencia, universidad y sociedad en la región latinoamericana

El objetivo de este trabajo es argumentar sobre la importancia del enfoque de redes de conocimiento, generado en el campo de los estudios sociales de la ciencia y la tecnología (CTS), para el análisis de las relaciones entre ciencia, universidad y sociedad. La construcción de procesos interactivos, cooperativos entre actores y el aprendizaje constituyen dimensiones clave para producir y utilizar conocimiento en la mejora del bienestar social de nuestras poblaciones. El trabajo expone brevemente las concepciones que han dominado en las políticas de ciencia y tecnología en la región latinoamericana; se argumenta sobre la importancia de los enfoques de redes de conocimiento y de la perspectiva regional y local al interior de los países, tanto para analizar la generación, intercambio y uso de conocimiento como para el diseño e implementación de políticas públicas de ciencia, tecnología e innovación; se documenta si en las nuevas concepciones de políticas de ciencia, tecnología e innovación en América Latina que destacan la importancia de la inclusión social se está adoptando el enfoque de redes de conocimiento y la perspectiva regional; y, se ofrecen, a manera de conclusiones, algunas argumentaciones sobre el futuro de las relaciones entre universidad y sociedad en lo que al desarrollo científico y tecnológico se refiere.