Evaluating policy decisions in health systems

Johnson, Benjamin J.

Title:

Evaluating policy decisions in health systems

dc.contributor.advisor	Serban, Nicoleta
dc.contributor.advisor	Swann, Julie
dc.contributor.author	Johnson, Benjamin J.
dc.contributor.committeeMember	Griffin, Paul M.
dc.contributor.committeeMember	Griffin, Susan
dc.contributor.committeeMember	Sokol, Joel
dc.contributor.department	Industrial and Systems Engineering
dc.date.accessioned	2017-08-17T19:01:08Z
dc.date.available	2017-08-17T19:01:08Z
dc.date.created	2017-08
dc.date.issued	2017-07-21
dc.date.submitted	August 2017
dc.date.updated	2017-08-17T19:01:08Z
dc.description.abstract	This thesis focuses on four policy decisions relevant in health systems today: (i) the impact of geographic distance to care on patients with cystic fibrosis, (ii) the impact of global health supply chain design on the health outcomes where they operate, (iii) the impact of three interventions to improve access to pediatric preventive dental care, and (iv) the cost effectiveness of using silver diamine for treating caries in young children. Chapter 2 evaluates the impact of geographic distance from cystic fibrosis centers on lung function in patients with cystic fibrosis. Clinical patient-level data on 20,351 patients for years 1986-2011 are evaluated from the Cystic Fibrosis Foundation National Patient Registry. Distance is measured using a patient’s zip code centroid to the center where they received care. A heteroscedastic mixed effects model is used to capture the association of distance with longitudinal variation in patients’ lung function. Chapter 3 includes a study of the USAID malaria supply chain design in the context of the health outcomes in each of the counties it operates. Malaria is a life-threatening mosquito-borne infectious disease that causes fevers, chills, and vomiting. Sub-Saharan Africa is both resource-constrained and has 90 percent of malaria related deaths. To combat the disease, global health agencies including USAID provide commodities necessary to prevent and treat malaria. The supply chain systems at these organizations are integral to the success of programs aimed to combat malaria. Using publically available data regarding malaria, global development, and the USAID malaria supply chain, the impact of funding levels, supply chain performance, and other global development and malaria indicators on malaria mortality are determined. Linear regression is used to determine if there is a significant association between supply chain factors and malaria health. Chapters 4 and 5 evaluate the existing state of access to preventive oral health in Georgia and three policy interventions to improve access to dental care for children in Georgia: i) loan repayment programs ii) revising Medicaid fee-for-service rates, and iii) changing dental hygienist supervision requirements. Met need, cost savings of preventive care, and the cost of implementation are estimated for the three interventions. Chapter 6 determines the cost saving potential and cost effectiveness of using silver diamine fluoride (SDF) to treat caries in young children. SDF is a cheap alternative to traditional restorative care. While it does not have the ability to restore the tooth completely, it provides a valuable treatment option for young children by potentially arresting the caries in affected primary teeth until are replaced with healthy permanent teeth. This study evaluates the potential of this treatment option using a simulation approach with costs based on the realized costs of Medicaid treatments.
dc.description.degree	Ph.D.
dc.format.mimetype	application/pdf
dc.identifier.uri	http://hdl.handle.net/1853/58720
dc.language.iso	en_US
dc.publisher	Georgia Institute of Technology
dc.subject	Health policy
dc.subject	Humanitarian logistics
dc.subject	Cystic fibrosis
dc.subject	Preventive care
dc.subject	Oral health
dc.subject	Silver diamine fluoride
dc.subject	Supply chain
dc.subject	Healthcare supply chain
dc.title	Evaluating policy decisions in health systems
dc.type	Text
dc.type.genre	Dissertation
dspace.entity.type	Publication
local.contributor.advisor	Serban, Nicoleta
local.contributor.corporatename	H. Milton Stewart School of Industrial and Systems Engineering
local.contributor.corporatename	College of Engineering
relation.isAdvisorOfPublication	63115986-db70-4c06-87c4-dab394286f67
relation.isOrgUnitOfPublication	29ad75f0-242d-49a7-9b3d-0ac88893323c
relation.isOrgUnitOfPublication	7c022d60-21d5-497c-b552-95e489a06569
thesis.degree.level	Doctoral