Bridging the Gulf on Health Care Policy Beyond the Affordable Care Act

This article presents a brief overview of the Affordable Care Act (ACA) and changes ushered into the health care system by the Act. The overview is followed by arguments for and against the ACA, integrating and situating the divergent arguments within the context of both democratic and conservative standpoints on health care policy. Furthermore, the article explores the possibility of identifying factors responsible for the seeming difficulty in transiting policy from agenda status to adoption in a democratic system of governance. The article concludes with suggestions on ways and strategies that can help in bridging the ostensible gap between divergent positions, with the hope of charting the course to the desired destination of an equitable and sustainable health care policy for the United States.

Innovations in Internet of Medical Things, Artificial Intelligence and Readiness of Health Care Sector towards Health 4.0 Adoption

Recent years witnessed lots of advancements in Internet of Medical Things, Innovations in Artificial Intelligence and Big Data Analytics based health care practices. Further, recent pandemic has compelled health care institutions to adopt remote patient care practices throughout the world and India is not an exception. Growth in mobile infrastructure and cheap mobile data packages also encouraged adoption of telemedicine and m-health care practices in India which eventually supports attempts of health care policy makers for transition of traditional health care systems to Health 4.0 in the lines of industry4.0. However, success of Health 4.0 depends upon the coordinated efforts from all the stakeholders. In this regard this research has been conducted to investigate the current status of Health 4.0 implementation in India and readiness of Indian health care sector towards its adoption. This paper further employs the SWOT-AHP analysis to identify the current areas that need immediate improvement to facilitate Health 4.0 adoption.

Photovoice Exploration of Frontline Nurses’ Experiences During the COVID-19 Pandemic

Background The current COVID-19 global pandemic has had a profound impact on the health care system and on the physical and psychological well-being of nurses. Previous pandemics have led to nurses leaving the profession. Therefore, it is important that we hear the voices of nurses who experienced the pandemic on the frontlines to influence future planning and policy development. Purpose The purpose of this study was to explore frontline nurses’ experiences during the COVID-19 pandemic through photos, narratives, and group discussions. Methods Twelve nurses in two groups shared their lived experiences through Photovoice, a participatory action approach. Photos and narratives were collected over five weeks per group. One group at the beginning of the pandemic and the other group six months later. Focus group discussions were held following each group. Results Five themes emerged from the photovoice data: (1) The work of nursing; (2) Miscommunication; (3) Fatigue; (4) Resilience; and (5) Hope for the future. Various subthemes were noted within each theme to delineate the lived experience of frontlines nurses working in the COVID-19 pandemic. Conclusions The voices of nurses and their experiences on the frontlines of the COVID-19 pandemic need to be considered in pandemic planning and integrated into health care policy, guidelines, and structural changes.

Testing Kissick’s Iron Triangle—Structural Equation Modeling Analysis of a Practical Theory

Background/Purpose: The purpose of this research is to determine if the tradeoffs that Kissick proposed among cost containment, quality, and access remain as rigidly interconnected as originally conceived in the contemporary health care context. Although many have relied on the Kissick model to advocate for health policy decisions, to our knowledge the model has never been empirically tested. Some have called for policy makers to come to terms with the premise of the Kissick model tradeoffs, while others have questioned the model, given the proliferation of quality-enhancing initiatives, automation, and information technology in the health care industry. One wonders whether these evolutionary changes alter or disrupt the originality of the Kissick paradigms themselves. Methods: Structural equation modeling (SEM) was used to evaluate the Kissick hypothetical relationships among the unobserved constructs of cost, quality, and access in hospitals for the year 2018. Hospital data were obtained from Definitive Healthcare, a subscription site that contains Medicare data as well as non-Medicare data for networks, hospitals, and clinics (final n = 2766). Results: Reporting significant net effects as defined by our chosen study variables, we find that as quality increases, costs increase, as access increases, quality increases, and as access increases, costs increase. Policy and Practice Implications: Our findings lend continued relevance to a balanced approach to health care policy reform efforts. Simultaneously bending the health care cost curve, increasing access to care, and advancing quality of care is as challenging now as it was when the Kissick model was originally conceived.

Efficiency of the primary health care policy in Brazilian municipalities: an application of the Pearl’s Structural Causal Model

ABSTRACT Background In recent years, public health policies and their effects on improving health outcomes have been gaining prominence in the economic literature and on the agenda of international organizations. Objective This study aims to evaluate the causal effect of the “Pacto pela Saúde” (Pact for Health) program on health policy performance in terms of a Health Vulnerability Index (HVI) of Brazilian municipalities from 2006 to 2013. The “Pacto pela Saúde” program is the current operational standard of the Brazilian Unified Health System (SUS). One of the main guidelines of this program was to improve health policy governance. Method The effect resulting from efficiency gains of the participation of municipalities in the health policy on the HVI was estimated by the Pearl’s Structural Causal Model. Results The results indicate a positive and significant impact of efficiency management on the reduction of health vulnerability in the municipalities. The Pearl’s Causal Model and the back-door criterion of causal identification were employed to calculate the effects of the “Pacto pela Saúde” program on the HVI. Conclusion The use of Pearl’s method in this study contributed to a more comprehensive analysis of the effects of the “Pacto pela Saúde” program on health outcomes and, therefore, its use in future research on the analysis of public policies is recommended.

Testing Kissick’s Iron Triangle - Structural Equation Modeling Analysis of a Practical Theory

The purpose of this research is to determine if the tradeoffs that Kissick proposed among cost containment, quality, and access remain as rigidly interconnected as originally conceived in the contemporary health care context. Although many have relied on the Kissick model to advocate for health policy decisions, to our knowledge, the model has never been empirically tested. Some have called for policy makers to come to terms with the premise of the Kissick model tradeoffs, others have questioned the model given the proliferation of quality enhancing initiatives, automation, and information technology in the health care industry. One wonders whether these evolutionary changes alter or disrupt the originality of the Kissick paradigms themselves. Methods: Structural Equation Modeling (SEM) was used to evaluate the Kissick hypothetical relationships among the unobserved constructs of cost, quality, and access in hospitals for the year 2018. Hospital data were obtained from Definitive Healthcare a subscription site which contains Medicare data as well as non-Medicare data for networks, hospitals, and clinics (final n= 2,766). Results: Reporting significant net effects as defined by our chosen study variables, we find that as quality increases costs increase, as access increases quality increases, and as access increases, costs increase. Policy and Practice Implications: Our findings lend continued relevance to a balanced approach to health care policy reform efforts. Simultaneously bending the health care cost curve, increasing access to care, and advancing quality of care is as challenging now as it was when the Kissick model was originally conceived.

Adoption and Appropriateness of mHealth for Weight Management in the Real World: A Qualitative Investigation of Patient Perspectives

Background Mobile health (mHealth) interventions for weight management can result in weight loss outcomes comparable to in-person treatments. However, there is little information on implementing these treatments in real-world settings. Objective This work aimed to answer two implementation research questions related to mHealth for weight management: (1) what are barriers and facilitators to mHealth adoption (initial use) and engagement (continued use)? and (2) what are patient beliefs about the appropriateness (ie, perceived fit, relevance, or compatibility) of mHealth for weight management? Methods We conducted semistructured interviews with patients with obesity at a single facility in an integrated health care system (the Veterans Health Administration). All participants had been referred to a new mHealth program, which included access to a live coach. We performed a rapid qualitative analysis of interviews to identify themes related to the adoption of, engagement with, and appropriateness of mHealth for weight management. Results We interviewed 24 veterans, seven of whom used the mHealth program. Almost all participants were ≥45 years of age and two-thirds were White. Rapid analysis identified three themes: (1) coaching both facilitates and prevents mHealth adoption and engagement by promoting accountability but leading to guilt among those not meeting goals; (2) preferences regarding the mode of treatment delivery, usability, and treatment content were barriers to mHealth appropriateness and adoption, including preferences for in-person care and a dislike of self-monitoring; and (3) a single invitation was not sufficient to facilitate adoption of a new mHealth program. Themes were unrelated to participants’ age, race, or ethnicity. Conclusions In a study assessing real-world use of mHealth in a group of middle-aged and older adults, we found that—despite free access to mHealth with a live coach—most did not complete the registration process. Our findings suggest that implementing mHealth for weight management requires more than one information session. Findings also suggest that focusing on the coaching relationship and how users’ lives and goals change over time may be an important way to facilitate engagement and improved health. Most participants thought mHealth was appropriate for weight management, with some nevertheless preferring in-person care. Therefore, the best way to guarantee equitable care will be to ensure multiple routes to achieving the same behavioral health goals. Veterans Health Administration patients have the option of using mHealth for weight management, but can also attend group weight management programs or single-session nutrition classes or access fitness facilities. Health care policy does not allow such access for most people in the United States; however, expanded access to behavioral weight management is an important long-term goal to ensure health for all.

Patient’S Knowledge of Cardiovascular Diseases Risk Factors and Associated Factors Among Adult Cardiac Patients in Selected Health Institutions; A Cross Sectional Study, Addis Ababa, Ethiopia 2021 G.C.

Background cardiovascular related disorders are a major public health challenge in globally as well as in Ethiopia. It is crucial to improve the life style of the community at the same time it is a key for health care policy to give emphasis for prevention by educating the community by different ways. Therefore, the current study patient’s knowledge about risk factors related to those diseases. Method A facility-based descriptive cross-sectional study design was conducted. 420 Participants selected by systematic random sampling technique from April 01, 2021 until Jun 28, 2021 and met the criteria were included. Data was collected by interviewer-administered questionnaire. Level of knowledge was assessed by the Heart Disease Fact Questions. Bivariate and multivariate logistic regression was done to identify factors associated with identified class of knowledge. P-value less than 0.05 was considered as to indicate statistical significances. Result The result showed that most of the study subjects were in the age range of >54. The mean age was 48.7 ± 13 years. 255(62.7%) were females. 300(71.6%) of participants have sufficient knowledge toward cardiovascular diseases risk factors. Age, Sex, Place of residence, Status of education and Marital status was significantly associated with Participant’s knowledge (p<0.05, 95% C. I). Conclusion The majority of participants had sufficient knowledge regarding cardiovascular diseases risk factors. Maintaining good status, implementation of innovative interventions and structured, nurse-led lifestyle counseling would be required to effectively guide patients.

Findings on Loneliness, Telehealth, and Advance Care Planning From the National Poll on Healthy Aging

The University of Michigan National Poll on Healthy Aging (NPHA) taps into the perspectives of older adults to inform health care policy and practice using a nationally representative sample of more than 2,000 adults age 50-80. Questions about lack of companionship and feelings of loneliness were tracked over three time points; 34% expressed feelings of loneliness in October 2018, 41% in June 2020, and 37% in January 2021. The NPHA also found that use of telehealth increased from 4% in May 2019 to 30% in June 2020 to 43% in January 2021. Finally, the NPHA found that 37% have completed both medical durable power of attorney and advance directive with 7% completing at least one of these documents in the first three months of the COVID-19 pandemic. These poll results can be used to inform actions by coalitions and organizations to advance state and federal policy.