program planning final

Belmont

_____ report:

o   stemmed from Tuskegee Experiment 

o   1974, the national research law created the national commission for the protection of human subjects of biomedical and behavioral research 

nuremberg

·       ________ trials: Medical Case after WWII on research crimes

• Nazi experiments on prisoners: high altitude, freezing, twins, sulfa drugs, poison, TB, Phosgene, transplantation, sterilization → set new conditions for research 

• Subjects must have knowledge, voluntary consent, ability to end participation 

• Scientists in charge are responsible for:

  •  scientific basis or validity of hypothesis 

  • Terminate experiments likely to cause injury, disability, death 

respect, justice

Ethical principles in research involving humans

1.     ____ for persons 

2.     Beneficence: promotion of well-being (maximize benefit, minimize harm) 

3.     _____

institutional

IRB (______ review board)

o   identify the basic ethical principles that should underlie the conduct of biomedical and behavioral research involving humans species (and animals).

Includes: 

o   At least 5 people; qualified people, diverse groups represented, knowledgeable, outside member

o   except, expedited, full review

assent

informed consent

o   Implied consent: by completing the survey you consent

o   _____: 4th grade – 17

o   “If you don’t want your child to be present sign this otherwise we will assume they can” 

o   Deception: can be vague but not deceiving

issues, reporting

·       Anonymity and confidentiality

·       Data _____ (misuse, manipulation, analyses) vs ______ results (withholding, conflict of interest, duplication, plagiarism)

economic evaluation

_______ ________ of public health programs: the systematic appraisal of costs and benefits of projects, normally undertaken to determine the relative economic efficacy of programs (Is the program worth it?)

o   Applied analytic methods to identify, measure, value, and compare the costs and consequences of treatment and prevention strategies

allocation

·       Purpose: maximize outcomes, minimize costs, resource ______, demonstrate value (return on investment)

illness (COI)

5 types-partial and full economic evaluation analyses

1.     Cost of _____ Analysis

• Estimates total costs incurred b/c of disease

• Reported as: annual total cost, avg per person lifetime cost

•  Shows potential benefits of prevention efforts

cost(CA)

5 types-partial and full economic evaluation analyses

2. _____ analysis

• Estimates total costs of running a program

• Realizing costs from varying perspectives; important for budget justification, decision making, forecasting

• First step of full economic evaluation

cost benefits

5 types-partial and full economic evaluation analyses

3. _____ _______ analysis

   • Method used to compare costs & benefits of intervention

   •   All costs & benefits are standardized/valued in monetary terms

   • Compare next savings of programs that have entirely different benefits. (Bike helmet program vs elderly fall)

   • Less useful when benefits defined as lives saved

net benefits

cost-benefit analysis provides a single value:

____ ______: NB

benefits ($) divided by cost ($)

willingness

Quantify benefits of CBA

• Cost-of-Illness approach vs _____ to pay (how much is society willing to pay to reduce the annual morbidity & mortality risk associated disease or injury)

CBA used to

competing, implement

CBA is used to…

•   Choose among _____ options

  • implement program w/ highest NB

• Decide whether to ____ specific programs

  • Net benefit > 0 “____”

  For setting priorities on options given resource constraints

utility (CUA)

5 types-partial and full economic evaluation analyses

4. Cost ______ analysis

   • Method used to compare costs & benefits of interventions where benefits are expressed as # of life years saved adjusted to account for loss of quality

   • Combines

     • length of life (survival) & quality of life 

ratio

CUA Cont

• Compares disparate outcomes in terms of utility 

  • Quality adjusted life years (QALY)

  • Disability adjusted life years (DALY)

    • Defines a ____ of cost per health outcome 

    • $/QALY or $/DALY

QUALITY OF LIFE; CUA

CUA is used when

• ____ ___ _____ is the important outcome 

• When the program affects both morbidity & mortality 

• Ranging outcomes 

• Program being compared w/ program that has already been evaluated using ____ 

CA

First step of full economic evaluation?

CUA

which evaluation uses QALY & DALY

cost effectiveness

5 types-partial and full economic evaluation analyses

5. ______ ________ analysis

   • Estimates costs & outcomes of interventions

   • Expresses outcomes in natural units (cases prevented; lives saved) 

   • Compares results w/ other interventions affecting the same outcome                

ratio

Cost effectiveness analysis

• Summary measure: cost effectiveness ____  

• Cost per outcome achieved (cost per case prevented, cost per life saved) 

common; worth; empirical

• Used to identify

  • most cost effective strategy from options that produce _____ effect 

  • practices that are not ____ their costs

• Used for _____ support for under funded programs

ok!

read over

lobby

Economic evaluation & policy

o   Information —> _____ for more prevention resources to reduce burden

o   Economic evaluation is valuable to decision making & for setting health policy; important special

investment

o   Return on _____: the cost to implement effective interventions – economic intervention prevention

centralized

financing of public health

Types of governmental health structures

• ______: local health units are primarily led by employees of the state

decentralized

financing of public health

Types of governmental health structures

• ________: local health units are primely led by employees of local government

benefits

____ of decentralized : priorities meet local level needs; more accountable to local stakeholders; better fulfill local health needs; increased flexibility & transparence

poorer, workload

drawbacks of decentralized: _____ communities lack revenue; increased ______ of local frontline workers; mismanagement of funds; lack of training or capacity

mixed

financing of public health

Types of governmental health structures

• ________: some local health units are led by employees of the state and some are led by employees of local government

shared governance of health department

financing of public health

Types of governmental health structures

• ________: local health units might be led by employees of state or by employees of local gov.

fiscal

Shared: If led by state —> local gov has authority to make ____ decisions or issue public health orders

state

Shared: If led by local gov —> _____ has authority “”

federal

·       Mechanisms of financing:

• ______: block (broad discretion) or categorial (specific; competitive & formula based)

  • Mixture of population based formula grant programs, incidence or prevalence based formulas, and a series of competitive grants

state & county

·       Mechanisms of financing:

---

• ____ & _____ gov revenues through appropriation process

• Varies dramatically based on state governance and health department structure/activities; taxes

statute

·       Mechanisms of financing:

• _____ language mandating state funding to local health agencies (LHA)

program

·       Mechanisms of financing:

• ____ Fees & fines

  • Newborn screenings

  • Environmental health

    • Regulation & licensing (healthcare, facilities, body art salons)

    • Inspection certifications (restaurants, residential buildings)

    • Permits (swimming pools, water systems, mobile home parks)

reports, insurance

program fees & fines cont

• ____ & certificates

  • Vital records (birth, death, marriage

• _____: Medicaid, private insurance  

tax

·       Mechanisms of financing:

•   _____:

  • property tax

  • sales tax

  • tobacco excise tax

  • taxing districts: need authority from state for local taxing districts

    • mosquito control, TB, property taxes

funding, unpopular

taxes

• benefits/limitations 

  • ability to align local _____ with local priorities

  • avoid annual funding fluctuation

  •  ______

federal

·       Sources of funding of public health: health departments received most ______ funds via USDA, CDC, HRSA, EPA, FDA

authorizations; competitive, law

Factors influencing flow of funding from federal to other levels

o   Congressional _______ & appropriations directives/limits

o   Eligibility varies by funding opportunity

o   Not all eligible apply for each opportunity

o   Most federal funding awarded via a ______ or merit-based process; not all that apply are funded

o Some funding allocated according to a pre-set formula which is sometimes specified in by ___

congress

U.S. Congress relationship to public health funding

o   Only _____ can raise revenue, borrow funds, and provide funding to federal agencies

• decides: what each agency is authorized to do; purpose of funds; amount of funds; amount of time the funds are available to be spent; other parameters

legislations, transfers, fees

Ways CDC receives congressionally authorized/appropriated funding

o   Annual appropriations process

o   Individual pieces of congressional ______ appropriating funding anytime during the FY

o   User ____ congress authorizes CDC to collect for services (CDC vessel sanitation program)

o   _____ from other federal agencies:

• funded activities must still fall under CDC authorities;

• funds must be used according to original congressional intent

president, hhs, cdc

·       Formal players: ____ (office of management & budget); ___ Secretary; ___ director, leadership, programs, congress

transfer; little

· Grants:

o   Most appropriate when principle purpose is to ____ a thing of value, money, property, or services to the recipient to carry out public purpose

• ____ involvement expected on part of issuing agency

• requires completion of program activities by the funded org only   

• ____ grants are non-discretionary        

categorical

• _____ grants are specific ie: funds for diabetes must go to diabetes

FOAs

• ___: the document all federal agencies use to announce the availability of grant funds to the public    

cooperative

_______ agreements: used when the principal purpose of the relationship is to transfer a thing of value & agency is expected to provide substantive involvement in carrying out the activities

• Includes substantial participation on the part of the CDC

single, diverse

Observations: no ____ solution

o   Funding must be a _____ mix of sustainable revenue streams beyond what currently exist

increased; highly

• Public health business model: public support for _____ funding in some but not all public health priority areas

• Public health is highly reliant on federal gov funding

fiscal

• ____ year (FY): Year of budgetary process, sometimes follows a calendar year, sometimes doesn’t

• State, territory, local, and tribal gov have own fiscal cycles (different than fed)

1, 30

o   Fed: Starts October __ and ends September _

• FY18= October 1 2017 – September 30 2018

yes.

·       Funding for public health flowchart- know who holds purse strings for diff labels