Orton | HPAA 99

Anticipating the Future Needs of the Elderly Population of Alamance County

Tyler Foster

Abstract

This paper focuses on health care delivery for elders in Alamance County, North Carolina, using North Carolina and the United States as benchmarks. Demographics of Americans sixty-five and older and the baby boom population are different from previous generations, requiring changes in the delivery of health care. There are a growing number of elderly, demanding an increasing level of care.

The growth of a vulnerable population with high medical care needs is a major issue for policy makers who are having increasing problems funding care for the elderly. long term care is becoming harder to pay for because of medical inflation, increases in the numbers of elders, and the fact that people are living longer. Funds that have been set up to pay for elderly care--Medicare, Medicaid, and Social Security--are depleting.

My needs assessment addresses changing demographic concerns and current access problems for elders of Alamannce County, and explores the services, programs, and support groups provided by Alamance Regional Medical Center (ARMC) and community agencies. Calculations are made on how many patients these services will need to serve in future years and suggestions are made on which services need to be expanded.

A four-part plan in preparing for the changing demographics of elders is presented to administrators at ARMC and other community agencies. It is suggested that they expand existing services as needed and add additional services through alliances and partnerships, tailor services toward elderly preferences, better train their staff to meet the needs of the elderly, and prepare financially for the future of Medicare, Medicaid, and Social Security by becoming more efficient and by petitioning the state for additional funding.

An Analysis of the Under-Utilization of Early Periodic Screening, Diagnosis and Treatment Services (EPSDT) in Northeast Tennessee

Sree Lakshmi Degala

Tennessee has been very aggressive in pursuing federal and state partnership opportunities to provide all of its children with health insurance. The State was one of the first in the 1980s to take advantage of expansions in Medicaid eligibility. In the 1990s, Tennessee adopted Medicaid managed care and blended the federal Child Health Insurance Program expansion opportunity to offer the most extensive public coverage of any state through a program called Tenncare. It is estimated that 39% of the state's children have coverage through Tenncare, Tennessee's Medicaid program.

The state has also promoted adherence to the policy goal that every child has a primary care provider. Through its contracts with managed care organizations, the state has atempted to assure that children have continuity of care for acute, chronic and preventive services.

One paradigm to a system of services, based on a population management approach, is a program initiated through Medicaid in the 1960s, the Early Periodic Screening, Diagnosis and Treatment (EPSDT) program. EPSDT services in Tennessee are under investigation by federal and state government due to their low utilization rate. This honors thesis will attempt to identify the reasons for EPSDT under-utilization. The research is designed to identify the weakness of the EPSDT program, the sources of those weakness, and explain those weaknesses and possible solutions.

. . . . .

[from the conclusion]

The successful delivery of EPSDT services in Tennessee relies on participation from four parties--Tenncare, MCOs, providers, and members--and each group has fallen short of its responsibility to the program. The major source of inefficiency in the program is the lack of proper communication between each party, which has resulted in the segmented delivery of EPSDT services.

Research on the Low Birth Weight of Indian Newborns in the US and Recommendations for Improvement

Neha B. Shah

Due to the growing population of Indians as well as the impact of low birth weight, the problem of low birth weight must be addressed. The purpose of this paper is to identify the possible causes of low birth weight and propose solutions to remedy them. Moreover, these solutions will be vital to help meet the national standards set by the United States Public Health Service.

. . . . .

[From the conclusion]

Low birth weight [among Indians in the US] is due to many factors ranging from lack of pre-natal care, inadequate diet and nutrition, no regular exercise routine, and vast cultural differences. Factors such as alcohol, income level and educational status do not come into play for this population.

Because there has been little or no research focused on the Indian population, this problem has not been recognized by many as being significant. However, as the US Public Health Service attempts to attain its goals of reducing low birth weight outcomes, this problem has begun to surface. Moreover, since low birth weight has such an important and predictive bearing upon future health outcomes, this project is even more imperative to bring into the limelight. The Indian population within the United States has grown exponentially and will continue to grow significantly over the next twenty to thirty years.

Optimizing Prescription Drug Use in Canada

Tim O'Brien

Substantial increases in the consumption and price of prescription drugs are becoming of increasing concern in Canada and around the world. Problems with prescription medication related to the consumption and ocst include inappropriate selection of drug(s), under-prescribing, over-prescribing, and patient non-compliance with the medication. Investigators have studied factors associated with prescribing and have also attempted to alter prescribing through various interventions. problems related to prescribing medication have been introduced in each of the provincial and territorial governments. During my twelve-week internship, I became very familiar with the problems associated with prescribing.

The purpose of my thesis is to explore the problems with prescribing in Canada based on survey responses from key stakeholders, and to determine what types of reforms can be implemented to optimize prescription drug use.

Analysis of Prevention Methods for Fighting the Pread of HIV/AIDS Using the Saheli Project: A Case Study

Rina Khemlani

The purpose of this paper is to determine the ideal type of HIV/AIDS prevention program for commercial sex workers in the red light districts of Bombay, India. The paper reviews information gathered on three different prevention projects in Bombay and attempts to fit them into existing theoretical models of health behavior change.

. . . . .

[from the conclusion]

• Fundamental similarities exist between the three programs reviewed.
  
  
• The Health Belief Model constructs of perceived barriers, perceived benefits, perceived susceptibility and perceived severity did relate to the way these preventions programs changed the behavior of commercial sex workers.
  
  
• The Theory of Reasoned Actoin constructs of attitude and norms did relate to the way these prevention programs changed the behavior of commercial sex workers.
  
  
• The Health Belief Model seemed to relate better than the Theory of Reasoned Action to the way prevention programs changed the behavior of commercial sex workers.
  
  
• A combination of the Health Belief Model with the added construct of norms (peer influences) from the Theory of Reasoned Action seemed to best describe the way prevention programs should be modeled for changing the health behavior of this population.

The Influence of Managed Care on Clinical Laboratories: A Case Study of UNC's Department of Obstetrics and Gynecology's Alpha-fetoprotein Laboratory

Tamyra Reams

Abstract

As managed care contracting becomes a greater part of healthcare practices, managers of clinical settings must find ways to lower their cost of providing service. One of the best means of doing this is through the use of Activity Based Costing.

After researching the topic of Activity Based Costing, I developed a case study of UNC's Department of OGYN's Alpha-fetoprotein (AFP) Laboratory to illustrate how managers can use this analysis in their practices.

ABC analysis results indicate the advantages of using this analysis because it not only specifies costs to the activity level, but the analysis also reveals how unrecognized costs affect the cost per unit. In the case study of the AFP Laboratory, costs were found to be more than seen using traditional costing methods. For managers in this situation, this knowledge is very valuable when negotiating for managed care contracts. Without it, managers risk underbidding and perhaps assuming debt they may never have realized.

The results are also useful in helping managers address methods for reducing the cost of service. Some suggestions mentioned in the paper include renegotiating with suppliers and reengineering the production process.

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