Evaluating policy decisions in health systems

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Johnson, Benjamin J.
Serban, Nicoleta
Swann, Julie
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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.
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