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16. Health Sector Reform in the Kurdistan Region-Iraq: Primary Care Management Information System, Physician Dual Practice Finance Reform, and Quality of Care Training

Author

Anthony, C. Ross, Moore, Melinda, Hilborne, Lee H., Rooney, Anne, Hickey, Scot, Ryu, Youngbok, and Botwinick, Laura

Subjects
education, Health Care Delivery, Quality, and Patient Safety
Abstract

Since 2010, the RAND Corporation has worked with the Ministry of Health and Ministry of Planning of the Kurdistan Regional Government to develop and implement initiatives for improving the region's health care system through analysis, planning, and development of analytical tools. This third phase of the project (reflecting work completed in 2013-2015) focused on development and use of a primary care management information system; health financing reform, focusing on policy reform options to solve the problem of physician dual practice, in which physicians practice in both public and private settings; and hospital patient safety training within the context of health quality improvement. Most main primary health care centers serve too many people, and most sub-centers serve too few people. Staffing by physicians, nurses, dentists, and pharmacists is uneven across the region. The data also identified centers where laboratory, X-ray, and/or other equipment should be repaired or replaced and where users should be trained. Though the required workweek is 35 hours, and all physicians are paid for these 35 hours, most physicians spent only three or four hours per day working in the public sector. The remainder of the time was often spent working in the private sector, where pay is much higher. The vast majority of physicians (over 80 percent) indicated that if pay were higher and public-sector resources were increased, they would prefer to work only in the public sector. To resolve the problems associated with dual practice, the authors recommend full separation between public- and private-sector practice.

Published
2018

18. The RAND SLAM Program

Author

RAND NATIONAL DEFENSE RESEARCH INST SANTA MONICA CA, Klerman, Jacob A., Ordowich, Christopher, Bullock, Arthur M., Hickey, Scot, RAND NATIONAL DEFENSE RESEARCH INST SANTA MONICA CA, Klerman, Jacob A., Ordowich, Christopher, Bullock, Arthur M., and Hickey, Scot

Abstract

This report describes the RAND SLAM program. The RAND SLAM program allows an analyst to explore the trade-offs inherent in military force structure decisions. More specifically, the program allows an analyst to examine trade-offs among cost, stress, and risk when the requirement for deployed forces varies over time. The RAND SLAM program's unique features allow an analyst to study the effects of varying military requirements on force structure decisions. Optimal force structures can vary dramatically depending on the nature of the threat. For this reason, the RAND SLAM program models contingencies stochastically, acknowledging that military requirements vary unpredictably over time and allowing an analyst to study the implications. The report contains a number of illustrative analyses focusing on the force structure of the U.S. Army. Many of the analyses that have been performed in support of force structure decisions have been very narrowly focused. The power of the RAND SLAM program is that it allows an analyst to perform many different types of analysis under almost any set of assumptions. The program's primary focus is allowing an analyst to determine the lowest-cost force structure for a given requirement and stress level. However, the program can also perform many other types of analyses, such as determining the effect of different requirements on stress levels for a given force structure. The RAND SLAM program was designed to provide as much flexibility as possible. The user determines both the unit of analysis and the time resolution for each set of simulation runs. The program is capable of utilizing any unit of analysis -- individual, company, battalion, brigade, etc. -- and modeling any time resolution -- days, months, quarters, years, etc. The RAND SLAM program allows the user to move beyond the typical analysis of finding the optimal active-reserve mix. The user can create new types of forces and examine their attractiveness under varying assumptions., ISBN 978-0-8330-4212-5

Published
2008

19. Terrorism Risk Modeling for Intelligence Analysis and Infrastructure Protection

Author

RAND CORP SANTA MONICA CA, Willis, Henry H., LaTourrette, Tom, Kelly, Terrence K., Hickey, Scot, Neill, Samuel, RAND CORP SANTA MONICA CA, Willis, Henry H., LaTourrette, Tom, Kelly, Terrence K., Hickey, Scot, and Neill, Samuel

Abstract

When are terrorists likeliest to attack next? Will they use chemical, biological, radiological, or nuclear (CBRN) weapons or resort to sabotage or conventional attacks? What locations and facilities will they target? What economic impact would a conventional attack on a piece of critical infrastructure have in comparison with a nuclear attack? The Office of Intelligence and Analysis (OI&A) at DHS is responsible for using information and intelligence from multiple sources to identify and assess current and future threats to the United States. This report documents the results of analysis using a risk-analysis tool, the Risk Management Solutions (RMS) Probabilistic Terrorism Model, to help OI&A with this challenge., ISBN-13: 978-0-8330-3974-3

Published
2007

23. Will public health's response to terrorism be fair? Racial/ethnic variations in perceived fairness during a bioterrorist event.

Author

Eisenman DP, Wold C, Setodji C, Hickey S, Lee B, Stein BD, and Long A

Subjects
Adult, Attitude to Health, Data Collection, Delivery of Health Care, Female, Humans, Male, Middle Aged, Public Opinion, Socioeconomic Factors, Bioterrorism, Ethnicity, Prejudice, Public Health, Racial Groups
Abstract

Objectives: Public health departments' effectiveness during catastrophic bioterrorism will require trust on the part of diverse communities. This study describes variations in perceptions that the public health system will respond fairly to one's needs in a bioterrorist event, regardless of race/ethnicity, income, or other characteristics., Methods: Using the Los Angeles County Health Survey, a random-digit, population-based, telephone survey, we conducted multivariate logistic regression of race/ethnicity on perceived fairness, adjusting for demographic factors and perceived neighborhood safety. We performed similar analyses stratified by race/ethnicity subgroup., Results: Overall, 72.7% of respondents perceived that the public health system will respond fairly in a bioterrorist event. African Americans (AA) and Asian/Pacific Islanders (API) reported the lowest perceived fairness (AA 63.0%, API 68.2%, Latino 73.1%, White 76.6%, p = 0.005 for group differences). Adjusting for demographic factors and neighborhood safety, African Americans had lower perceived fairness compared to whites (adjusted odds ratio, aOR 0.45; 95% confidence intervals, CI 0.26-0.79; p < 0.005). Other factors associated with lower perceived fairness included Asian-language compared to English-language interview (aOR 0.29; 95% CI 0.11-0.76; p < 0.05) and lower compared to higher neighborhood safety (aOR 0.48; 95% CI 0.31-0.74; p < 0.005). Among African Americans, participants aged 18-29 years were less likely to report perceived fairness (aOR 0.06; 95% CI 0.01-0.59) compared to participants older than 60 years of age. Among Asian/Pacific Islanders, Asian-language interview (aOR 0.07; 95% CI 0.01-0.48) and lower perceived neighborhood safety (aOR 0.01; 95% CI <0.01-0.13) were associated with perceived fairness., Conclusions: To strengthen bioterrorism preparedness, public health officials must continue to improve perceived fairness among African American and Asian/Pacific Islander communities.

Published
2004
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