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1.
Am J Public Health ; 112(1): 116-123, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34936404

RESUMO

Arguing for the importance of robust public participation and meaningful Tribal consultation to address the cumulative impacts of federal projects, we bridge interdisciplinary perspectives across law, public health, and Indigenous studies. We focus on openings in existing federal law to involve Tribes and publics more meaningfully in resource management planning, while recognizing the limits of this involvement when only the federal government dictates the terms of participation and analysis. We first discuss challenges and opportunities for addressing cumulative impacts and environmental justice through 2 US federal statutes: the National Environmental Policy Act and the National Historic Preservation Act. Focusing on a major federal planning process involving fracking in the Greater Chaco region of northwestern New Mexico, we examine how the Department of the Interior attempted Tribal consultation during the COVID-19 pandemic. We also highlight local efforts to monitor Diné health and well-being. For Diné people, human health is inseparable from the health of the land. But in applying the primary legal tools for analyzing the effects of extraction across the Greater Chaco region, federal agencies fragment categories of impact that Diné people view holistically. (Am J Public Health. 2022;112(1):116-123. https://doi.org/10.2105/AJPH.2021.306562).


Assuntos
Participação da Comunidade , Tomada de Decisões , Política Ambiental/legislação & jurisprudência , Fraturamento Hidráulico/legislação & jurisprudência , Governo Federal , Regulamentação Governamental , Humanos , New Mexico/etnologia , Saúde Pública
3.
Health Aff (Millwood) ; 40(11): 1740-1748, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34724415

RESUMO

With the passage of the Affordable Care Act, states were given the option to expand their Medicaid programs. Since then, thirty-eight states and Washington, D.C., have done so. Previous work has identified the widespread effects of expansion on enrollment and the financial implications for individuals, hospitals, and the federal government, yet administrative expenditures have not been considered. Using data from all fifty states for the period 2007-17, our study estimated the effects of Medicaid expansion overall, as well as differing effects by the size and nature of the expansions. Using a quasi-experimental approach, we found no overall effect of expansion on administrative spending. However, the size of the expansion may have produced differing effects. States with small expansions experienced some increases in administrative spending, whereas states with large expansions experienced some decreases in administrative spending, including a $77 reduction in per enrollee administrative spending compared with nonexpansion states. As more states consider expanding their Medicaid programs, our findings provide evidence of potential effects.


Assuntos
Medicaid , Patient Protection and Affordable Care Act , Governo Federal , Gastos em Saúde , Humanos , Estados Unidos , Washington
4.
PLoS One ; 16(11): e0259362, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34739509

RESUMO

We analyze whether and to what extent strategies employed by governments to fight the COVID-19 pandemic made a difference for GDP growth developments in 2020. Based on the strength and speed with which governments imposed non-pharmaceutical interventions (NPIs) when confronted with waves of infections we distinguish between countries pursuing an elimination strategy and countries following a suppression / mitigation strategy. For a sample of 44 countries fixed effect panel regression results show that NPI changes conducted by elimination strategy countries had a less severe effect on GDP growth than NPI changes in suppression / mitigation strategy countries: strategy matters. However, this result is sensitive to the countries identified as "elimination countries" and to the sample composition. Moreover, we find that exogenous country characteristics drive the choice of strategy. At the same time our results show that countries successfully applying the elimination strategy achieved better health outcomes than their peers without having to accept lower growth.


Assuntos
COVID-19/epidemiologia , COVID-19/prevenção & controle , Governo Federal , Governo , Humanos , Internacionalidade , Modelos Econômicos , Pandemias , Distanciamento Físico , Política Pública , Quarentena , Análise de Regressão , Risco , SARS-CoV-2
5.
J Prim Health Care ; 13(2): 116-120, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34620292

RESUMO

During the first months of the coronavirus disease 2019 (COVID-19) pandemic in early 2020, South Korea stood as one of the most successful in preventing a nationwide outbreak. The country was unique in that it did so without enforcing massive border restrictions and tight social distancing measures, instead focusing on maximal testing, contact tracing, and treatment. But as the year 2020 went on, the country has suffered second and third waves, each one being larger and harder to combat than the last. The Korean government, however, has been unwilling to impose stringent measures due to potential economic consequences and has still relied on its initial strategies in an attempt to prevent further disease transmission. It is therefore crucial to revisit their position beyond their early successes to re-evaluate the effectiveness of their strategy, and to finally decide if it is time to move on to more drastic measures.


Assuntos
COVID-19/prevenção & controle , Controle de Doenças Transmissíveis , Pandemias/prevenção & controle , Teste para COVID-19 , Controle de Doenças Transmissíveis/economia , Controle de Doenças Transmissíveis/métodos , Busca de Comunicante , Governo Federal , Humanos , Distanciamento Físico , República da Coreia
8.
Rev Bras Enferm ; 75(2): e20200328, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34669896

RESUMO

OBJECTIVES: to reflect on the impacts of Brazil's response to the COVID-19 pandemic demands on the nursing labor market in light of the recovery of experiences in the USA during the World War II. METHODS: this is a discursive formulation, which discusses the nursing labor market, establishing analogies between historical events. RESULTS: measures implemented in the World War II by the USA are similar to those that the Brazilian Federal Government has adopted, and, as in the USA, such measures strongly affected both professional training and the nursing labor market. In Brazil, the measures can also deepen problems in the national nursing labor market, reverberating in precariousness. CONCLUSIONS: a better way to meet the demand for nursing workers can be with the existing supply of trained and available workers.


Assuntos
COVID-19 , Pandemias , Brasil , Governo Federal , Humanos , SARS-CoV-2
11.
Am J Nurs ; 121(11): 14, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34673679

RESUMO

Some states seek to limit health officials' powers to act in disease outbreaks.


Assuntos
Controle de Infecções/normas , Política , Enfermagem em Saúde Pública , Saúde Pública/legislação & jurisprudência , Governo Estadual , COVID-19 , Governo Federal , Humanos , Estados Unidos
14.
JAMA Netw Open ; 4(9): e2122885, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34499136

RESUMO

Importance: Federal data underestimate the impact of COVID-19 on US nursing homes because federal reporting guidelines did not require facilities to report case and death data until the week ending May 24, 2020. Objective: To assess the magnitude of unreported cases and deaths in the National Healthcare Safety Network (NHSN) and provide national estimates of cases and deaths adjusted for nonreporting. Design, Setting, and Participants: This is a cross-sectional study comparing COVID-19 cases and deaths reported by US nursing homes to the NHSN with those reported to state departments of health in late May 2020. The sample includes nursing homes from 20 states, with 4598 facilities in 12 states that required facilities to report cases and 7401 facilities in 19 states that required facilities to report deaths. Estimates of nonreporting were extrapolated to infer the national (15 397 facilities) unreported cases and deaths in both May and December 2020. Data were analyzed from December 2020 to May 2021. Exposures: Nursing home ownership (for-profit or not-for-profit), chain affiliation, size, Centers for Medicare & Medicaid Services star rating, and state. Main Outcomes and Measures: The main outcome was the difference between the COVID-19 cases and deaths reported by each facility to their state department of health vs those reported to the NHSN. Results: Among 15 415 US nursing homes, including 4599 with state case data and 7405 with state death data, a mean (SE) of 43.7% (1.4%) of COVID-19 cases and 40.0% (1.1%) of COVID-19 deaths prior to May 24 were not reported in the first NHSN submission in sample states, suggesting that 68 613 cases and 16 623 deaths were omitted nationwide, representing 11.6% of COVID-19 cases and 14.0% of COVID-19 deaths among nursing home residents in 2020. Conclusions and Relevance: These findings suggest that federal NHSN data understated total cases and deaths in nursing homes. Failure to account for this issue may lead to misleading conclusions about the role of different facility characteristics and state or federal policies in explaining COVID outbreaks.


Assuntos
COVID-19/epidemiologia , Casas de Saúde/estatística & dados numéricos , Viés , COVID-19/mortalidade , Estudos Transversais , Bases de Dados Factuais , Governo Federal , Humanos , Inquéritos e Questionários , Estados Unidos/epidemiologia
15.
JAAPA ; 34(7): 44-48, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34582397

RESUMO

ABSTRACT: Increasingly, physician assistants (PAs), advanced practice nurses, and physicians are financially involved with healthcare product manufacturers. Although the relationships themselves might not be illegal, when the transaction influences the healthcare provider's medical decision-making, patients can be harmed and the healthcare provider and manufacturer can face accusations of violating federal and state law. In 2019, the federal government recouped $2.6 billion from healthcare fraud and abuse by healthcare stakeholders. PAs' and NPs' behaviors violating the Anti-Kickback Statute (AKS) and False Claims Act (FCA) were partially responsible for the reported amount. To increase the transparency of the financial relationships between healthcare providers and healthcare manufacturers, the federal Centers for Medicare and Medicaid Services, under statutory obligation, created the Open Payments program, which will begin reporting PAs' and advanced practice nurses' financial relationships with manufacturers in 2022.


Assuntos
Medicare , Médicos , Idoso , Centers for Medicare and Medicaid Services, U.S. , Governo Federal , Fraude , Humanos , Estados Unidos
16.
Bone Joint J ; 103-B(10): 1555-1560, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34587804

RESUMO

AIMS: Knee arthroplasty surgery is a highly effective treatment for arthritis and disorders of the knee. There are a wide variety of implant brands and types of knee arthroplasty available to surgeons. As a result of a number of highly publicized failures, arthroplasty surgery is highly regulated in the UK and many other countries through national registries, introduced to monitor implant performance, surgeons, and hospitals. With time, the options available within many brand portfolios have grown, with alternative tibial or femoral components, tibial insert materials, or shapes and patella resurfacings. In this study we have investigated the effect of the expansion of implant brand portfolios and where there may be a lack of transparency around a brand name. We also aimed to establish the potential numbers of compatible implant construct combinations. METHODS: Hypothetical implant brand portfolios were proposed, and the number of compatible implant construct combinations was calculated. RESULTS: A simple knee portfolio with cemented cruciate-retaining (CR) and posterior-stabilized (PS) components, with and without a patella, has four combinations. If there are two options available for each component, the numbers double for each option, resulting in 32 combinations. The effect of adding a third option multiplies the number by 1.3. Introducing compatible uncemented options, with the effect of hybrids, multiplies the number by 4. An implant portfolio with two femoral components (both in CR and PS), with two insert options and a patella, all in cemented and uncemented versions leads to 192 possible compatible implant construct combinations. There are implant brands available to surgeons with many more than two options. CONCLUSION: This study demonstrates that the addition of multiple variants within a knee brand portfolio leads to a large number (many hundreds) of compatible implant construct combinations. Revision rates of implant combinations are not currently reviewed at this level of granularity, leading to the risk of camouflage of true outcomes. Cite this article: Bone Joint J 2021;103-B(10):1555-1560.


Assuntos
Artroplastia do Joelho/instrumentação , Benchmarking/métodos , Tomada de Decisão Clínica , Coleta de Dados/métodos , Prótese do Joelho , Avaliação de Resultados em Cuidados de Saúde/métodos , Desenho de Prótese , Artroplastia do Joelho/métodos , Benchmarking/normas , Coleta de Dados/normas , Governo Federal , Regulamentação Governamental , Humanos , Avaliação de Resultados em Cuidados de Saúde/normas , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Sistema de Registros , Reoperação/estatística & dados numéricos , Reino Unido
18.
Bioethics ; 35(8): 744-751, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34553398

RESUMO

The apportionment of responsibility for health policy within multi-level states should be sensitive to a number of conflicting normative pressures, some of which militate for placing decision-making authority at the higher reaches of policy-making structures, while others would seem to require placing them lower down this structure. The principle of subsidiarity is a structural principle that addresses in a manner that is neutral with respect to these values a way of addressing the conflicting claims of these values. Standard accounts of federalism fare poorly with respect to the criterion of subsidiarity. While central governments are at first glance better equipped to apply such a principle to the issue of the distribution of authority, there are strong empirical grounds for thinking that centralized governments will non-neutrally privilege central authorities in applying the principle. Federal structures that admit of overlapping jurisdictions, and that therefore require that deliberation among federal parties occur as a condition of the problem of the distribution of powers over health care being solved, are most amenable to solving problems of distribution of authority.


Assuntos
Governo , Política de Saúde , Atenção à Saúde , Governo Federal , Humanos , Formulação de Políticas
20.
Biomed Res Int ; 2021: 5763003, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34485519

RESUMO

Background: The dominant view in the literature is that informal payments in healthcare universally are a negative phenomenon. By contrast, we theorize that the motivation healthcare users for making informal payments (IP) can be classified into three categories: (1) a cultural norm, (2) "grease the wheels" payments if users offered to pay to get better services, and (3) "sand the wheels" payments if users were asked to pay by healthcare personnel or felt that payments were expected. We further hypothesize that these three categories of payments are differently associated with a user's outcomes, namely, satisfaction with healthcare, local and national government, satisfaction with life, and satisfaction with life of children in the future. Methods: We used microdata from the 2016 Life-in-Transition survey. Multivariate regression analysis is used to quantify relationships between these categories of payments and users' outcomes. Results: Payments that are the result of cultural norms are associated with better outcomes. On the contrary, "sand the wheel" payments are associated with worse outcomes. We find no association between making "grease the wheels" payments and outcomes. Conclusions: This is the first paper which evaluates association between three different categories of informal payments with a wide range of users' outcomes on a diverse sample of countries. Focusing on informal payments in general, rather than explicitly examining specific motivations, obscures the true outcomes of making IP. It is important to distinguish between three different motivations for informal payment, namely, cultural norms, "grease the wheels," and "sand the wheels" since they have varying associations with user outcomes. From a policy making standpoint, variation in the links between different motivations for making IP and measures of satisfaction suggest that decision-makers should put their primary focus on situations where IP are explicitly asked for or are implied by the situation and that they should differentiate this from cases of gratitude payments. If such measures are not implemented, then policy makers may unintentionally ban the behaviour that is linked with increased satisfaction with healthcare, government, and life (i.e., paying gratitude).


Assuntos
Gastos em Saúde/estatística & dados numéricos , Instalações de Saúde/economia , Motivação , Qualidade da Assistência à Saúde/economia , Governo Federal , Pesquisas sobre Serviços de Saúde , Instalações de Saúde/normas , Humanos , Satisfação Pessoal
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