scholarly journals An Evaluation of Alternatives for Providing Care to Veterans

2018 ◽  
Author(s):  
Lawrence V. Fulton ◽  
Matthew S. Brooks
Keyword(s):  
Policy Analysis ◽  
Medical Center ◽  
Objective Evaluation ◽  
Status Quo ◽  
Washington Dc ◽  
Quality Healthcare ◽  
Policy Interventions ◽  
The Status ◽  
Access And Quality ◽  
The Cost

In 2014, a whistleblower reported that many U.S. veterans died while waiting for care at the Phoenix VHA. Problems with veteran’s care through 2018 reveal ongoing and systematic problem.  In March 2018, the VA Inspector General identified critical deficiencies at the Washington, DC VA Medical Center including failures to track patient safety events accurately, ineffective sterile processing, and more than 10 thousand open or pending prosthetic / sensory aid consults. The VHA clearly has problems with access and quality in a budget-constrained environment.  In this policy analysis, four separate interventions that address the gap between the magnitude as well as the use of the VHA’s fixed budget versus access and cost expectations are explored. These policy interventions include maintaining the status quo, returning to a “VHA-only” option, transitioning to a CMS central payer system, and consolidating care under the DoD TRICARE insurance plans. An objective evaluation suggests that extending TRICARE to veterans while phasing out the VHA’s care responsibilities, while politically unpalatable, would likely provide the best of four possible solutions under various criterion weighting schemes.  A central payer solution under the CMS would also be viable consideration.  A Friedman’s test with Wilcoxon rank sum post-hoc tests suggests that TRICARE patient perceptions of quality are superior to VHA and non-VHA / non-DoD (p<.001), that access provided by the TRICARE program is ranked second in terms of venue acceptance only to the CMS solution set based on primary provider acceptance, and that the cost per beneficiary of a TRICARE solution ($6.5K / beneficiary)  is far better than a VHA-only solution ($14.0 K / beneficiary), the CMS central payer solution ($12.2K / beneficiary), or the status quo (between $12.2K and $14.0K / beneficiary).  The intent of this paper is to provoke thoughtful consideration of solutions for providing access to high-quality healthcare for veterans within our outside of the VHA. In this policy analysis, separate interventions that address the gaps between cost, quality, and access are explored. These policy interventions include maintaining the status quo, returning to a VHA-only option, transitioning to a CMS central payer system, and consolidating care under TRICARE.

scholarly journals An Evaluation of Alternatives for Providing Care to Veterans

2018 ◽  
Author(s):  
Lawrence V. Fulton ◽  
Matthew S. Brooks
Keyword(s):  
Policy Analysis ◽  
Medical Center ◽  
Objective Evaluation ◽  
Status Quo ◽  
Washington Dc ◽  
Quality Healthcare ◽  
Policy Interventions ◽  
The Status ◽  
Access And Quality ◽  
The Cost

In 2014, a whistleblower reported that many U.S. veterans died while waiting for care at the Phoenix VHA. Problems with veteran’s care through 2018 reveal ongoing and systematic problem.  In March 2018, the VA Inspector General identified critical deficiencies at the Washington, DC VA Medical Center including failures to track patient safety events accurately, ineffective sterile processing, and more than 10 thousand open or pending prosthetic / sensory aid consults. The VHA clearly has problems with access and quality in a budget-constrained environment.  In this policy analysis, four separate interventions that address the gap between the magnitude as well as the use of the VHA’s fixed budget versus access and cost expectations are explored. These policy interventions include maintaining the status quo, returning to a “VHA-only” option, transitioning to a CMS central payer system, and consolidating care under the DoD TRICARE insurance plans. An objective evaluation suggests that extending TRICARE to veterans while phasing out the VHA’s care responsibilities, while politically unpalatable, would likely provide the best of four possible solutions under various criterion weighting schemes.  A central payer solution under the CMS would also be viable consideration.  A Friedman’s test with Wilcoxon rank sum post-hoc tests suggests that TRICARE patient perceptions of quality are superior to VHA and non-VHA / non-DoD (p<.001), that access provided by the TRICARE program is ranked second in terms of venue acceptance only to the CMS solution set based on primary provider acceptance, and that the cost per beneficiary of a TRICARE solution ($6.5K / beneficiary)  is far better than a VHA-only solution ($14.0 K / beneficiary), the CMS central payer solution ($12.2K / beneficiary), or the status quo (between $12.2K and $14.0K / beneficiary).  The intent of this paper is to provoke thoughtful consideration of solutions for providing access to high-quality healthcare for veterans within our outside of the VHA. In this policy analysis, separate interventions that address the gaps between cost, quality, and access are explored. These policy interventions include maintaining the status quo, returning to a VHA-only option, transitioning to a CMS central payer system, and consolidating care under TRICARE.

scholarly journals An Evaluation of Alternatives for Providing Care to Veterans

Healthcare ◽  
2018 ◽  
Vol 6 (3) ◽  
pp. 92 ◽  
Author(s):  
Lawrence Fulton ◽  
Matthew Brooks
Keyword(s):  
Medical Center ◽  
Objective Evaluation ◽  
Status Quo ◽  
Washington Dc ◽  
Quality Healthcare ◽  
Policy Interventions ◽  
The Status ◽  
Access And Quality ◽  
The Cost ◽  
Sterile Processing

In 2014, a whistleblower reported that many U.S. veterans died while waiting for care at the Phoenix VHA. Problems with veteran’s care through 2018 reveal ongoing and systematic problem. In March 2018, the VA Inspector General identified critical deficiencies at the Washington, DC VA Medical Center including failures to track patient safety events accurately, ineffective sterile processing and more than 10 thousand open or pending prosthetic/sensory aid consults. The VHA clearly has problems with access and quality in a budget-constrained environment. In this policy analysis, four separate interventions that address the gap between the magnitude as well as the use of the VHA’s fixed budget versus access and cost expectations are explored. These policy interventions include maintaining the status quo, returning to a “VHA-only” option, transitioning to a CMS central payer system and consolidating care under the DoD TRICARE insurance plans. An objective evaluation suggests that extending TRICARE to veterans during the phasing out the VHA’s care responsibilities, while politically unpalatable, would likely provide the best of four possible solutions under various criterion weighting schemes. A central payer solution under the CMS would also be a viable consideration. Results suggest that TRICARE patient perceptions of quality are superior to VHA and non-VHA/non-DoD, that access provided by the TRICARE program is ranked second in terms of venue acceptance only to the CMS solution set based on primary provider acceptance and that the cost per beneficiary of a TRICARE solution ($6.5 K/beneficiary) is far better than a VHA-only solution ($14.0 K/beneficiary), the CMS central payer solution ($12.2 K/beneficiary), or the status quo (between $12.2 K and $14.0 K/beneficiary). The intent of this paper is to provoke thoughtful consideration of solutions for providing access to high-quality healthcare for veterans within or outside of the VHA.

scholarly journals mCARE, a digital health intervention package on pregnancy surveillance and care-seeking reminders from 2018 to 2027 in Bangladesh: a model-based cost-effectiveness analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e042553
Author(s):  
Youngji Jo ◽  
Amnesty Elizabeth LeFevre ◽  
Hasmot Ali ◽  
Sucheta Mehra ◽  
Kelsey Alland ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Home Visit ◽  
Digital Health ◽  
Status Quo ◽  
Health Intervention ◽  
Text Messages ◽  
Care Seeking ◽  
Intervention Package ◽  
The Status ◽  
The Cost

ObjectiveWe estimated the cost-effectiveness of a digital health intervention package (mCARE) for community health workers, on pregnancy surveillance and care-seeking reminders compared with the existing paper-based status quo, from 2018 to 2027, in Bangladesh.InterventionsThe mCARE programme involved digitally enhanced pregnancy surveillance, individually targeted text messages and in-person home-visit to pregnant women for care-seeking reminders for antenatal care, child delivery and postnatal care.Study designWe developed a model to project population and service coverage increases with annual geographical expansion (from 1 million to 10 million population over 10 years) of the mCARE programme and the status quo.Major outcomesFor this modelling study, we used Lives Saved Tool to estimate the number of deaths and disability-adjusted life years (DALYs) that would be averted by 2027, if the coverage of health interventions was increased in mCARE programme and the status quo, respectively. Economic costs were captured from a societal perspective using an ingredients approach and expressed in 2018 US dollars. Probabilistic sensitivity analysis was undertaken to account for parameter uncertainties.ResultsWe estimated the mCARE programme to avert 3076 deaths by 2027 at an incremental cost of $43 million relative to the status quo, which is translated to $462 per DALY averted. The societal costs were estimated to be $115 million for mCARE programme (48% of which are programme costs, 35% user costs and 17% provider costs). With the continued implementation and geographical scaling-up, the mCARE programme improved its cost-effectiveness from $1152 to $462 per DALY averted from 5 to 10 years.ConclusionMobile phone-based pregnancy surveillance systems with individually scheduled text messages and home-visit reminder strategies can be highly cost-effective in Bangladesh. The cost-effectiveness may improve as it promotes facility-based child delivery and achieves greater programme cost efficiency with programme scale and sustainability.

The Inheriting and Development of Tradition - Analysis of Wang Shu’s Award Receipt and more Architectural Engineering Cases

2013 ◽  
Vol 357-360 ◽  
pp. 129-134
Author(s):  
Bin Quan Zhang ◽  
Yong Sheng Chen
Keyword(s):  
Economic Development ◽  
Natural Environment ◽  
Traditional Culture ◽  
Status Quo ◽  
Architectural Engineering ◽  
Social And Economic Development ◽  
The Status ◽  
City Construction ◽  
The Cost ◽  
The Way

City construction is beset with severe problems like homogenization, exotic style copy, barbaric development and short-lived buildings, jeopardizing the traditional culture as well as natural environment. Faced with the status quo, it is not feasible to protect the environment at the cost of social and economic development. City construction thus faces extruding problems. The solution of such problems calls for all-dimensional discussion. The practice of Mr. Wang Shu leads the way.

Moral Seriousness

Philosophy ◽  
1970 ◽  
Vol 45 (172) ◽  
pp. 114-127 ◽  
Author(s):  
Keith Ward
Keyword(s):  
Status Quo ◽  
Moral Principles ◽  
The Status ◽  
The Face ◽  
The Cost ◽  
Rule Out

What is it to be ‘morally serious’? In one sense, it is quite obvious that a man who stands by his moral principles with difficulty and in face of many obstacles, even to the extent of giving his life rather than denying these principles, is a morally serious person. He might be contrasted with a man who gives up or modifies his moral principles whenever their implementation becomes difficult, or threatens to harm his interests; and this person might be called morally frivolous. That is what moral seriousness is; but still, one might ask, what is it to be a morally serious man? What does it involve to be such a man? Is it just a sort of pathological obstinacy; even, perhaps, a misplaced conservatism in face of the facts, which clings to the principles it knows, whatever the cost? One cannot rule out such a possibility. But the martyr and the hero do not consider themselves to be merely obstinate. In the face of risk and even certain suffering, they typically regard it as of supreme importance to be obstinate in sustaining their principles. Something more is felt to be at stake than mere defence of the status quo.

Democracy Assistance for Botswana: Maintaining the Status Quo in a Peripheral Capitalist Country

2019 ◽  
Vol 35 (2) ◽  
pp. 205-229
Author(s):  
Kebapetse Lotshwao ◽  
Robert Imre ◽  
Jim Jose
Keyword(s):  
Civil Society ◽  
Status Quo ◽  
Political Regime ◽  
Democratic Institutions ◽  
Capitalist Country ◽  
State Institutions ◽  
Democracy Assistance ◽  
Multilateral Institutions ◽  
The Status ◽  
The Cost

Given that Botswana is considered a stable democracy, the need for democracy assistance does not at first glance seem necessary. Yet, democracy assistance is an important feature of Botswana’s political regime. The rationale for democracy assistance is couched in terms of strengthening the country’s democratic institutions, enhancing the state’s capacity, and bolstering Botswana’s civil society. However, contrary to these stated objectives, this article reveals that democracy assistance serves the agenda of Western donor countries and certain multilateral institutions—an agenda concerned with keeping Botswana politically stable and its state institutions efficient so that the country is attractive to investors. This agenda is pursued at the cost of not making certain long overdue political reforms.

Authoritarian Signaling, Mass Audiences, and Nationalist Protest in China

2013 ◽  
Vol 67 (1) ◽  
pp. 1-35 ◽  
Author(s):  
Jessica Chen Weiss
Keyword(s):  
Status Quo ◽  
International Crises ◽  
The Status ◽  
The Cost ◽  
Popular Mobilization

AbstractHow can authoritarian states credibly signal their intentions in international crises? Nationalist, antiforeign protests are one mechanism by which authoritarian leaders can visibly demonstrate their domestic vulnerability. Because protests in authoritarian states are risky and costly to repress, the decision to allow or stifle popular mobilization is informative. The threat of instability demonstrates resolve, and the cost of concession increases the credibility of a tough stance. The danger of instability and escalation increases foreign incentives to make concessions and preserve the status quo. This logic helps explain the pattern of authoritarian tolerance and repression toward nationalist protest. A case study of two U.S.-China crises shows how China's management of anti-American protests affected U.S. beliefs about Chinese resolve.

Resilience in social and economic systems: a concept that fails the cost–benefit test?

1998 ◽  
Vol 3 (2) ◽  
pp. 221-262 ◽  
Author(s):  
NICK HANLEY
Keyword(s):  
Cost Benefit Analysis ◽  
Social Systems ◽  
Cost Benefit ◽  
Status Quo ◽  
Economic Systems ◽  
Benefit Analysis ◽  
Ecological Concept ◽  
The Status ◽  
The Subject ◽  
The Cost

One of the first lessons that students of cost-benefit analysis (CBA) learn is to ask whether projects or policies which they are studying generate additional benefits or costs, relative to the status quo. They are also told to be very careful in defining the project/policy which is the subject of their analysis. In my view, the ecological concept of resilience fails the CBA test, when applied to the study of economic and social systems, because it offers no additional insights to those we have already, and appears to be poorly defined.

Academic Labor in the Age of Anxiety: Autoethnography Matters

2017 ◽  
Vol 17 (4) ◽  
pp. 320-326 ◽  
Author(s):  
Elissa Foster
Keyword(s):  
Emotional Experience ◽  
Academic Work ◽  
Status Quo ◽  
Academic Life ◽  
Institutions Of Higher Education ◽  
Academic Organizations ◽  
Work Program ◽  
Academic Labor ◽  
The Status ◽  
The Cost

In this autoethnographic essay, I reflect on three spheres of academic work—program administration, teaching, and scholarship—and find evidence of the effects of neoliberalism in each sphere of practice. Specifically, I articulate the prevailing emotional experience of my academic work as anxiety, which is a consequence of internalizing the construction of students-as-consumers and responding uncritically to the demands of academic organizations that require my compliance and neutrality. To the extent that academic freedom is a reward afforded to those with tenure, my essay argues that the cost of leading a privileged academic life is that we use our privilege to question the status quo, particularly in our own institutions of higher education.

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