gary gaumer | Simmons University (original) (raw)

Papers by gary gaumer

This study estimated the impacts of PEPFAR on all-cause mortality (ACM) rates (deaths per 1,000 p... more This study estimated the impacts of PEPFAR on all-cause mortality (ACM) rates (deaths per 1,000 population) across PEPFAR recipient countries from 2004-2018. As PEPFAR moves into its 3rd decade, this study supplements the existing literature on PEPFAR 's overall effectiveness in saving lives by focusing impact estimates on the important subgroups of countries that received different intensities of aid, and provides estimates of impact for different phases of this 15-year period study. The study uses a country-level panel data set of 157 low-and middle-income countries (LMICs) from 1990-2018, including 90 PEPFAR recipient countries receiving bilateral aid from the U.S. government, employing differencein-differences (DID) econometric models with several model specifications, including models with differing baseline covariates, and models with yearly covariates including other donor spending and domestic health spending. Using five different model specifications, a 10-21% decline in ACM rates from 2004 to 2018 is attributed to PEPFAR presence in the group of 90 recipient countries. Declines are somewhat larger (15-25%) in those countries that are subject to PEPFAR's country operational planning (COP) process, and where PEP-FAR per capita aid amounts are largest (17-27%). Across the 90 recipient countries we study, the average impact across models is estimated to be a 7.6% reduction in ACM in the first 5-year period (2004)(2005)(2006)(2007)(2008), somewhat smaller in the second 5-year period (5.5%) and in the third 5-year period (4.7%). In COP countries the impacts show decreases in ACM of 7.4% in the first period attributed to PEPFAR, 7.7% reductions in the second, and 6.6% reductions in the third. PEPFAR presence is correlated with large declines in the ACM rate, and the overall life-saving results persisted over time. The effects of PEFAR on ACM have been large, suggesting the possibility of spillover life-saving impacts of PEPFAR programming beyond HIV disease alone.

African Journal of AIDS Research, Nov 30, 2023

PubMed, May 27, 1999

Context: The Medicare program is encouraging its beneficiaries to enroll in capitated health plan... more Context: The Medicare program is encouraging its beneficiaries to enroll in capitated health plans. Objective: To determine how prepared these plans are to handle chronically ill and frail elderly persons. Design: Telephone survey of 28 health plans that together serve about one fourth of all enrollees of the Medicare Risk program. Measures: The degree of readiness (high, intermediate, or low) of health plans in seven domains that experts believe are important to the management of an elderly population. Results: None of the 28 health plans had high readiness scores for all seven domains. The two domains for which the plans were most prepared were risk assessment and member self-care. The plans were least prepared for the domains of cooperative team care and geriatric consultations. Conclusions: Many plans do not offer the programs that experts believe are important for Medicare enrollees. They may hesitate to adopt strategies that lack data on effectiveness.

PubMed, Dec 1, 1987

This article examines the relationship between the introduction of State prospective reimbursemen... more This article examines the relationship between the introduction of State prospective reimbursement (PR) programs and mortality rates for elective surgery. We study 15 such programs using a sample of about 40 percent of U.S. hospitals. We examine mortality data for 1974 to 1983 for these hospitals, selecting a 20-percent sample of all Medicare admissions for eight elective procedures. Indirect standardization (age, sex, procedure) was used to define mortality outcomes, and regression procedures were used to estimate PR effects that controlled for hospital, community, and other regulatory influences. Introduction of PR is found to be occasionally and inconsistently associated with increases in relative mortality.

PubMed, Dec 1, 1979

Two similar primary care training programs for family practice residents and for medical students... more Two similar primary care training programs for family practice residents and for medical students are compared to find differences and similarities in costs and the use of certain nonmonetary resources. Both programs emphasize long-term continuity, and trainees in both programs average two half-days per week at ambulatory care practice sites. Comparisons of the resource requirements of teaching high-continuity primary care curriculum segments between graduate and undergraduate programs will help determine where scarce medical teaching resources can be most beneficially used. It is hypothesized that there would be lower faculty costs, higher auxiliary staff and space requirements, and larger patient panel requirements for the residency program than for the undergraduate program. Extent of these differences could not be predicted. In the residency program, faculty costs were one quarter of total expenses and in the undergraduate program they were half of the program expenses. The residency recouped 81 percent of expenses from practice revenues while the undergraduate program recouped only 59 percent. The residency program averaged 814 visits per trainee during one year; the undergraduate program had only 268 visits per student.

PubMed, Feb 1, 1992

The introduction of Medicare's prospective payment system (PPS) has led to changes in the way hos... more The introduction of Medicare's prospective payment system (PPS) has led to changes in the way hospitals are being used. This article examines concomitant changes in the use of Medicare-covered services during the last 90 days of life, using data on more than 34,000 Medicare beneficiaries who died during the years 1982-1986. We focus on questions pertaining to changes in practice patterns that include location of death, hospital utilization, use of other covered services, and spending. We find that use of hospitals and other health services by Medicare beneficiaries during the last 90 days of life changed markedly over this period, which included the introduction of PPS in late 1983. The percentage of deaths occurring in hospitals decreased sharply from 1982 to 1986, especially in PPS states relative to waivered states; this effect seems primarily due to reductions in length of stay rather than reduced admission rates, which did not change significantly. Use of home care, durable medical equipment (DME), and physicians' office services also increased sharply during the last 90 days of life, but with no consistent evidence that the introduction of PPS was associated with these changes or with the level or mix of Medicare expenditures for these patients. Medicare spending in this period of life rose at the same rate as medical care price inflation, and about 75 percent of reimbursements continued to be hospital payments, despite the utilization changes.

Partners for Health Reformplus is USAID's flagship project for health policy and health system st... more Partners for Health Reformplus is USAID's flagship project for health policy and health system strengthening in developing and transitional countries. The five-year project (2000-2005) builds on the predecessor Partnerships for Health Reform Project, continuing PHR's focus on health policy, financing, and organization, with new emphasis on community participation, infectious disease surveillance, and information systems that support the management and delivery of appropriate health services. PHRplus will focus on the following results: p Implementation of appropriate health system reform. p Generation of new financing for health care, as well as more effective use of existing funds. p Design and implementation of health information systems for disease surveillance. p Delivery of quality services by health workers. p Availability and appropriate use of health commodities.

Journal of the American Dental Association, Feb 1, 2019

Background. Caries risk assessment (CRA) tools could address oral health disparities and enhance ... more Background. Caries risk assessment (CRA) tools could address oral health disparities and enhance the efficiency of the oral health care system. The authors aimed to explore the feasibility and limitations of using clinical CRA tools in informing oral health care policy-making processes. Methods. The authors used the National Health and Nutrition Examination Survey to construct 10 CRA models from a sample of clinical CRA tools identified from the literature. They used these models to estimate the proportion of publicly insured people aged 1 through 20 years categorized as at low, moderate, and high risk, and they projected their oral health care costs. Results. The authors found substantial variation among the selected models in assigning risk levels. The weighted average proportions (range) of people categorized as at low, moderate, and high risk were 25% (0%-66%), 14% (0%-50%), and 61% (11%-100%), respectively. Depending on the CRA model, the projected annual cost of covering this population ranged from 18billionto18 billion to 18billionto127 billion. Conclusions and Practical Implications. Developing a valid, evidence-based, accurate, and reliable population-based CRA model could address the variability among clinical CRA tools, improve estimates of dental disease burden, help design targeted oral public health programs, and enable comparative effectiveness analyses among oral health care interventions. Key Words. Caries; burden of caries; caries risk assessment; cost of oral health care; oral health care policy; vulnerable population; preventative oral health care.

Cin-computers Informatics Nursing, Nov 1, 2007

The purpose of this study is to describe the use of information technology by advance practice nu... more The purpose of this study is to describe the use of information technology by advance practice nurses. A survey of 519 graduates of the Simmons College nurse practitioner program was conducted. Areas of investigation included the nurse practitioner&amp;amp;amp;amp;amp;amp;amp;#39;s use of informatics technology, perception of information technology competence, adequacy of information technology training and support in the workplace, specific information technology health functions used in the workplace, and perceived benefits of using information technology. The data on the 249 usable responses were analyzed using descriptive statistics. These analyses compare the use of information technology by type of job, specialty, years of practice, and setting of work. Results indicate that more than 90% of nurse practitioners utilize computers at work, yet a large fraction of them still have low self-perception of information technology competence, believe initial training at the work site was inadequate, and believe that academic preparation for information technology was also inadequate. There is considerable variation in these measures across nurse practitioner specialties, settings of care, job characteristics, and experience.

PubMed, 2001

In fall 1998 CMS implemented the National Medicare Education Program (NMEP) to educate beneficiar... more In fall 1998 CMS implemented the National Medicare Education Program (NMEP) to educate beneficiaries about their Medicare program benefits; health plan choices; supplemental health insurance; beneficiary rights, responsibilities, and protections; and health behaviors. CMS has been monitoring the implementation of the NMEP in six case study sites as well as monitoring each of the information channels for communicating with beneficiaries. This article describes select findings from the case studies, and highlights from assessment activities related to the Medicare & You handbook, the toll-free 1-800-MEDICARE Helpline, Internet, and Regional Education About Choices in Health (REACH).

Social Science & Medicine. Part C: Medical Economics, 1978

Input/output analysis can provide an economic model of the health care system which is capable of... more Input/output analysis can provide an economic model of the health care system which is capable of characterizing financial flows, describing health system interrelationships and predicting the impacts of policy alternatives on the entire health care system. The need for such a model is demanded by ever increasing health care expenditures made without proper planning and the necessity that Health System Agencies have available a conceptual framework for collecting, organizing and analyzing the regional health care industry. Most previous regional economic efforts have been community flow of funds studies modeled after the SSA national expenditure series. Such studies have been descriptive, lacking a fully interactive interpretation of local health care. Econometric models usually deal only with specified sets of relationships and require great technical expertise. While input/output has been recognized as a superior model, its feasibility has been questioned. Input/output can provide a useful summary of finanacial interpendencies and a powerful forecasting tool. The input/output matrix describes the regional financial flows. Predictions of impacts for various policy alternatives are derived from fixed linkages between elements of the model through the development of coefficients indirecting direct and indirect relationships. An input/output study conducted in the Rockford, Illinois SMSA for 1972 indicates that the methodology is feasible for organizations with good local rapport. Key methodological problems, sectoring and data requirements, can be overcome, though stability of coefficients is still a valid concern. Examples are shown how the model can provide increased understanding of the local health care system in the local economy, including knowledge of impacts of potential changes such as conforming to plans, using alternative delivery methods or variations in demand.

PubMed, Mar 8, 1997

A national survey was conducted among rural hospitals active in teleradiology and their affiliate... more A national survey was conducted among rural hospitals active in teleradiology and their affiliated health care providers to delineate the current status of rural telemedicine. 109 telemedicine programs were identified that use teleradiology as well as other telemedicine applications, and 340 programs were identified that use only teleradiology. Programs that use only teleradiology have been in operation longer than programs that combine teleradiology with other telemedicine services. Most teleradiology facilities are adjacent to small metropolitan areas or in more rural counties with a population of at least 2500. Only 22% of the teleradiology-only facilities spend more than 60,000oninitialequipment,andannualtransmissioncostsaveragelessthan60,000 on initial equipment, and annual transmission costs average less than 60,000oninitialequipment,andannualtransmissioncostsaveragelessthan4,000 for most facilities. Ordinary copper telephone lines are the transmission medium most commonly used for transfer of radiology images. Radiographs and CT scans are the types of studies most commonly transmitted, followed by MRI and nuclear medicine studies.

The United States President’s Emergency Plan for AIDS Relief (PEPFAR) has been credited with savi... more The United States President’s Emergency Plan for AIDS Relief (PEPFAR) has been credited with saving millions lives and helping to change the trajectory of the global human immunodeficiency virus (HIV) epidemic. This study assesses whether PEPFAR has had impacts beyond health by examining changes in five economic and educational outcomes in PEPFAR countries: the gross domestic product (GDP) per capita growth rate; the share of girls and share of boys, respectively, who are out of school; and female and male employment rates. We constructed a panel data set for 157 low- and middle-income countries between 1990 and 2018 to estimate the macroeconomic impacts of PEPFAR. Our PEPFAR group included 90 countries that had received PEPFAR support over the period. Our comparison group included 67 low- and middle-income countries that had not received any PEPFAR support or had received minimal PEPFAR support (<$1M or <$.05 per capita) between 2004 and 2018. We used differences in differenc...

The Journal of the American Dental Association, 2019

Health care financing review, 2001

The Milbank Memorial Fund quarterly, 1984

to health care cost-containment, existing systems for regulating health professionals are being s... more to health care cost-containment, existing systems for regulating health professionals are being scrutinized. The federalized system of control mechanisms for credentialing, together with the procedures of accreditation, institutional rationing of practice privileges, peer review, malpractice actions, and the like, supplies a complex and often redundant array of regulations. These devices are manipulated by several federal agencies, each of the 50 states, professional groups, and several private organizations. These regulations are perceived by many to be a significant barrier to ongoing efforts to encourage costcontainment through more widespread use of competitive incentives in the health care industry. Health manpower regulations govern the locations and settings within which professionals can work and the activities of professionals in the course of their practice. The justification for these controls is the belief that the public interest will best be served if poorly trained, incompetent, and unethical people are kept from practicing. If these regulations are effective, they will ensure the patients' safe treatment by prohibiting some people from pursuing careers and will appropriately modify the behavior of practicing professionals. An unfortunate by-