Health Care at Birth and Infant Mortality: Evidence from Nighttime Deliveries in Nigeria December 29, 2017
Ensuring that Nigerian women giving birth have access to health facilities will likely reduce infant mortality.
Access to health care usually refers to the ease with which an individual can gain entry to or receive needed medical services. RAND research addresses multiple dimensions of access, including: financial access, usually facilitated through health insurance; potential access, usually aided by having a regular health care provider; and realized access, when an individual actually receives needed medical care. Many RAND studies have also examined disparities in access across different population groups and the effect of disparities on health.
Ensuring that Nigerian women giving birth have access to health facilities will likely reduce infant mortality.
The dissertation assesses the impact of nurse practitioner scope-of-practice regulations in primary care.
Promising early-stage trial results provide hope that a therapy for Alzheimer's disease may become available that can prevent progression to full-blown dementia. But an important challenge will arise: A substantial backlog of existing cases with early-stage disease would have to be screened, diagnosed, and then potentially treated. This report assesses the preparedness of the U.S. health care system to handle the potential caseload.
Community coalition building may increase use of health care services for depression.
While the ACA's Dependent Coverage Expansion has increased insurance coverage, it has also widened race/ethnic disparities because it benefits only those young adults whose parents have private coverage.
Direct-to-consumer telehealth may increase access by making care more convenient for certain patients, but it may also increase utilization and health care spending.
Telehealth services to support lactation may hold particular promise, but additional research is needed to determine whether the benefits outweigh potential challenges.
The overarching aim of this work is to evaluate the role of R&D on PRNDs in contributing to achieving UHC and improving population health in low- and middle-income countries.
For the years 2013 and 2014, the Affordable Care Act authorized enhanced payments for qualifying providers of primary care services participating in the Medicaid program that would be funded entirely by federal dollars. RAND researchers conducted a nine-state independent case study into stakeholder experiences planning for, implementing, and evaluating the impact of the policy to inform the design of similar, future payment policies.
Internet chat and text messaging offer anonymity and increased access to suicide hotline callers, but they are not yet a replacement for telephone crisis support services.
Innovative uses of telemedicine - such as previsit communication and postvisit follow up - could improve care by optimizing, rather than replacing, in-person visits.
Since the end of the Great Recession, disparities in the likelihood of forgone care have increased from pre-recession levels between African-Americans and whites; this may be a result of issues related to access, cost, and quality.
Home visits delivered by a nurse-parent educator team reduced children's health care use in the first year of life.
The American Health Care Act would increase uninsurance among veterans and demand for Department of Veterans Affairs care by a greater margin than simply returning to pre–Affordable Care Act levels of coverage.
Efforts to organize and consolidate the wide range of support services designed to bolster resilience in military families could enhance service members' mission readiness.
Legislators in Indiana are considering the expansion of scope-of-practice (SOP) to include full prescriptive authority for advanced practice registered nurses (APRNs). This report examines the literature related to the relationship between state APRN SOP regulations and health care delivery, and it estimates the effect on the state of Indiana if the legislature were to define a full SOP for APRNs.
The authors estimated how an influx of newly insured patients through the Affordable Care Act's coverage expansion may change the way that civilian providers choose to interact with the TRICARE program. The report culminates in lists and maps of counties where civilian physicians are most likely to face financial incentives to substitute newly insured patients for current TRICARE patients.
Under the ACA's dependent coverage expansion, there has been an increase in behavioral health treatment and a decrease in high out-of-pocket expenses and ER visits among young adults.
A 3-year demonstration to strengthen the delivery of primary care in federally qualified health centers provides some empirical evidence in support of medical-home transformation..
Organizations that use telehealth to address safety net clinic needs by recruiting retired or semi-retired doctor volunteers can help improve access to physicians in underserved areas while enriching the professional lives of clinicians.
The authors assessed an expansion of Vermont's Dr. Dynasaur program that would cover all residents age 25 and younger. The current Dr. Dynasaur program combines the state's Medicaid program and Child Health Insurance Program for children ages 0 through 18 to provide health coverage for children with family incomes below 317 percent of the federal poverty level. They modeled effects on health insurance coverage, costs, and premiums.
This analysis of three options to reform health care payment in Oregon (two state-based plans that would ensure coverage for all state residents and a state-sponsored plan offered in Oregon's nongroup market) found benefits and trade-offs for each.
A multi-disciplinary intervention using a Chronic Care Model framework to prevent a secondary stroke among underserved populations will be tested in a randomized controlled trial.
The use of mental health telemedicine among rural Medicare patients varies dramatically across states and is highly concentrated both in terms of who receives and who provides this care.
Exposing medical students and residents to rural practice during their training is a promising approach to addressing the shortfall of providers in rural communities.
Compared with non-Hispanic whites and US-born Hispanics, a larger proportion of African Americans and Hispanics used depression care provided by community faith-based organizations.
Many Los Angeles-area African American churches provide recovery supports and services for alcohol and other drug (AOD) use and actively connect individuals to formal AOD treatment.
Children with medical complexity (CMC) account for disproportionately high hospital use. Researchers developed a structured, reproducible process for the creation of intervention strategies to reduce hospitalizations among CMC.
This report provides a summary of the Technical Expert Panel (TEP), detailing input on the development of Post-Acute Care cross-setting standardized patient assessment data.
Embedding registered nurses into primary care teams can increase patient access to primary care services and alleviate organizational workload.
Medicaid enrollees are less likely than those with private insurance to see a dermatologist or receive care for a skin condition, suggesting that efforts need to be made to increase access to skin specialists.
This report describes the Affordable Care Act's (ACA's) effects on nonelderly veterans' insurance coverage and demand for Department of Veterans Affairs (VA) health care and assesses the coverage and VA utilization changes that could result from repealing the ACA.
Drugs to halt the progression of Alzheimer's disease may be available by 2020, but millions of U.S. patients might have to wait more than 14 months for initial appointments in the multistep process unless health care system capacity is increased.
This report examines an important factor in the ability to access dental care: the distribution and availability of dental health providers. The authors assess these characteristics of providers across the counties of Pennsylvania, primarily using data from the 2013 Survey of Dentists and Dental Hygienists administered by the Pennsylvania Department of Health.
Strengthening positive attitudes toward female veterans may matter more than changing women’s health practice characteristics alone.
In this Perspective, the authors discuss the risk that strategic behavior by health insurers could unravel the market for curative therapies for chronic diseases. Because the cost of these cures is front-loaded but the benefits accrue over time, insurers might attempt to delay treatment or avoid patients who require it, in the hope that they might change insurers. The authors present a framework to analyze policy options to remedy this problem.
This summary presents results from RAND's assessments of veteran demographics and health care needs, the health care capabilities of the Veteran's Administration (VA), and authorities and mechanisms for purchasing care. It also includes recommendations from the reports for improving the match between veterans' needs and VA's capabilities, including VA's ability to purchase necessary care from the private sector.
Despite efforts to integrate behavioral health care into primary care in the military health system, members of the military continue to perceive barriers to mental health care access. Issues remain with capacity, culture, and care quality.
Improving veterans' access to behavioral health care requires a systems perspective that engages both the VA and civilian health care professionals.
This report summarizes the approaches, findings, and recommendations of four studies intended to help the Kurdistan Regional Government expand access to high-quality education and health care, increase private-sector development and employment for the expanding labor force, and design a data-collection system to support high-priority policies. The detailed findings appear in four separate reports.
This executive summary summarizes what is known about the scope of childhood poverty in the United States today, as well as its effects on health and well-being for U.S children.
By expanding the reach of HIV testing programs, church-based testing events could help achieve the goal of universal testing.
RAND evaluated the Unified Behavioral Health Center for Military Veterans and Their Families, a new model of behavioral health care that provides colocated and coordinated care for veterans and their families.
Political and governance considerations should play a central role in the national conversation about improving health and health equity.
Policies that support collaboration between the formal health system and organizations in partner sectors--housing, education, and transportation--are key to achieving a culture of health.
This study highlights the complexity of improving maternal and child health outcomes in developing countries, and shows that scaling up supply of midwives may not be sufficient on its own.
Offering teledermatology appeared to improve access to dermatology care among Medicaid enrollees and played an especially important role for the newly enrolled.
A policy to promote mental health-based general medical care--specifically health monitoring and health physicals--was embraced by specialty mental health clinics in New York State.
Having a medical home may lead to higher perceived quality of care for children; however, children who lost medical home status may have more ER visits, compared with children whose status was not interrupted.
The Washington State legislature has recently considered several policy options to address a perceived shortage of primary care physicians in rural Washington. RAND Corporation researchers projected the effects that various policy options could have on Washington State's rural primary care workforce through 2025. This report presents background information, the researchers' methods, and their findings.
In April 2014 a new model for liaison and diversion schemes, which operate primarily in police custody suites and courts and aim to identify and assess people with vulnerabilities as they pass through the criminal justice system, was implemented in ten areas of England. An evaluation was commissioned by the Department of Health to look at the implementation of the new model in these sites.
For minor health conditions, retail clinics deliver care of equivalent quality to other settings. Most clinic users lack access to a primary care provider. Retail clinics slightly increase health care use and, consequently, health care spending.
Changing scope of practice regulations in Michigan to allow nurse practitioners to autonomously diagnose, treat, and prescribe medications could increase access to care, improve favorable utilization of care, and improve patient-centeredness.
Medicaid financial losses at children's hospitals greatly exceed losses at other types of hospitals.
Health care experiences of Latino children living in areas of the United States with newly expanding Latino populations do not differ significantly from their peers in more established Latino communities.
Four examples of engaging stakeholders in health care related research provide insight for current efforts and show that clear articulation on the purpose of engagement can affect how stakeholders are included and lead to better outcomes.
RAND researchers examine the existing literature on the relationship between state scope-of-practice regulations for nurse practitioners and various health care delivery outcomes (provider supply, access to care, utilization of care, costs of care, and quality of care), then estimate the impact in Michigan if its legislature expanded that scope of practice.
Integrating primary and behavioral health care may increase access to care for individuals with severe mental health illness; it may also reduce hospitalizations and related costs.
Internet and computer-based treatments (ICTs) are a promising way to increase access to treatment for post-traumatic stress disorder.
National efforts are underway to integrate medical care and behavioral health treatment.
The Medical Alumni Volunteer Expert Network (MAVEN) Project created a corps of experienced volunteer physicians to provide consults to providers in safety-net clinics via telehealth. This qualitative evaluation describes the program's strengths and limitations and provides lessons learned for other telehealth initiatives being developed in the United States.
Addressing persistent structural and policy barriers to adult immunization will benefit all Americans.
The goal of this study was to examine the effects of a new model for well-child care abstract (WCC), the Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT), on WCC quality and health care utilization among low-income families.
The Nigerian Midwives Service Scheme (MSS) is an ambitious human resources project created in 2009 to address supply side barriers to accessing care.
Ugandan men who have sex with men face many barriers to HIV treatment related to stigma among health care providers and the community.
Most veterans with alcohol misuse reported receiving advice to reduce or abstain from drinking.
The research looks at health insurance plans chosen by employees at a Fortune 500 company once they were allowed to configure their own plans.
Efforts to address stunted growth among children <5 y old worldwide could yield long term benefits of $3 for every $1 invested.
Integrating medical care, public health, and social services will increase access to care and improve health and well-being for all individuals.
An online intervention shows potential to improve veteran health care by using a novel approach to increase access to care, assist with drinking reductions, and prevent alcohol-related problems.
Many veterans and their families struggle with behavioral health, family reintegration, and relationship problems. However, unlike many veterans, family members are generally not eligible to receive care at Department of Veterans Affairs facilities. The Unified Behavioral Health Center is offering a new model of care by providing colocated and coordinated care for veterans and their families. This report presents an evaluation of this model.
This report describes the use of indirect estimation methods, such as Bayesian Indirect Surname Geocoding, to estimate racial/ethnic populations in health care records, which often lack such data, and the use of such methods to measure disparities in quality of care across racial/ethnic groups, as well as to monitor health care utilization and improvement.
Describes an evaluation of the impact of the Midwives Service Scheme, a government program introduced in 2009, which is intended to increase women's access to skilled care in rural underserved areas of Nigeria.
The Midwives Service Scheme (MSS) was introduced in 2009 to increase access to skilled care for women in rural underserved areas of Nigeria. To evaluate the impact of the MSS, researchers conducted household and clinic surveys, focus group discussions and in-depth interviews, and compared changes in pregnancy and birth outcomes in MSS areas to changes in comparison areas. They found smaller than anticipated effects.
The Affordable Care Act has reduced the number of uninsured; an emerging challenge is to help the newly insured choose coverage wisely and use it to access primary care and preventive services.
Veterans who rely on Department of Veterans Affairs (VA) health care are older and less healthy than veterans who do not, and the prevalence of health conditions in this population will increase. Not all eligible veterans use VA health care, and demand depends on such factors as access to other sources of health care. Analysis of a range of data sources provided insight into how the veteran population and demand for VA health care will change.
The Institute of Medicine identifies timeliness of care as a key aspect of quality.
To date, most Affordable Care Act implementation efforts have focused on getting individuals enrolled in health insurance coverage. Confirming that the newly insured access and remain engaged with appropriate health care has received less attention. This perspective describes lessons learned from conversations with a variety of health care industry stakeholders and calls for more-holistic thinking on ways to support consumers beyond enrollment.
RAND Corporation researchers identified three high-quality studies addressing the effect that scope-of-practice (SOP) laws can have on health-care access, quality, and costs and describe the potential effect of removing SOP restrictions for advanced practice registered nurses in the state of Ohio.
This study assesses the extent to which patients self-refer to cancer specialists and whether self-referral is associated with better experiences and quality of care.
This executive summary describes key results from four studies carried out by the RAND Corporation in Phase II of its work for the Kurdistan Regional Government (KRG). RAND's work aims to help the KRG expand access to high-quality technical and vocational education and training; improve access to, the quality of, and financing for health care; improve the private sector labor market; and prepare and conduct the Kurdistan Region Labor Force Survey.
This report will help policymakers in the Department of Veterans Affairs and other federal agencies develop and foster public-private partnerships to address the behavioral health care needs of veterans and their families. The authors develop nine key components that public-private partnerships for veteran behavioral health care would likely benefit from implementing or that could be used as a guide to develop partnerships between organizations.
The Department of Veterans Affairs (VA) provides timely and high-quality care to most of its patients, but there are inconsistencies in performance across VA facilities and barriers to effective use of VA resources and capabilities. VA will require more capacity to meet an increase in patient demand in the next five years. Options for increasing capacity include accelerated hiring, full nurse practice authority, and expanded use of telehealth.
Despite the potential benefits of telehealth applications, little is known about their overall impact on care. Teladoc appears to be expanding access to patients who are not connected to other providers.
Pediatric emergency telemedicine shares challenges with other telemedicine applications, but reimbursement is relatively less significant, and workflow disruption is relatively more significant in this setting.
Report provides the results of a California survey of colleges and universities on mental health experiences and attitudes, perceptions of campus mental health services, and perceptions of overall campus climate toward mental health and well-being.
Testimony presented before the House Energy and Commerce Committee, Subcommittee on Health on May 1, 2014.
Document submitted on June 5, 2014 as an addendum to testimony presented before the House Energy and Commerce Committee, Subcommittee on Health on May 1, 2014.
Many physician practices will face a set of critical decisions in the coming years that may contribute to the ultimate success or failure of the ACA.
This report describes the evaluation of the New Mexico Home Visiting Competitive Development Grant, which aimed to pilot test the use of implementation supports to improve the development and implementation of home visiting in high-need communities. It documents significant challenges in meeting grant goals, including use of the proposed implementation supports, initiation of home visiting programs, and building effective community coalitions.
Report assesses differences in racial and ethnic groups' exposure to suicide prevention messaging, preferences for suicide crisis services, and confidence in their ability to intervene with persons at risk of suicide.
The study determined rates of reengagement in services for individuals with serious mental illness who had discontinued services.
Report assesses the types of resources, ranging from face-to-face interactions with mental health professionals to texting a crisis line, that adults in California prefer to utilize for suicidal thoughts or feelings.
To help the District of Columbia Healthy Communities Collaborative lay a factual foundation for community health decisionmaking, this interactive web tool draws attention to specific findings in the community health needs assessment in a format that is user friendly and can help to inform the public.
Simulated patient, or so-called mystery-shopper, studies are a controversial, but potentially useful, approach to take when conducting health services research.
There is growing recognition that many physician–patient encounters do not require face-to-face contact.
This study supports the idea that e-visits could lower health care costs.
This study was a cross-sectional analysis of the 2007 National Survey for Children's Health, a nationally representative survey of 91 642 parents.
This report guides the District of Columbia Healthy Communities Collaborative's decisions about where and how to allocate resources and implement appropriate health interventions for the population it serves. The community health needs assessment described in this report includes quantitative analysis of existing demographic, health status, and hospital service use data for the District of Columbia, as well as analysis of current stakeholder perspectives, health policy, and investment priorities.
RAND works closely with the Centers for Medicare & Medicaid Services to design, test, implement, and evaluate demonstration projects that span a wide range of care settings and issues.