IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v145y2015icp98-106.html
   My bibliography  Save this article

The political economy of a public health case management program's transition into medical homes

Author

Listed:
  • Wells, Rebecca
  • Cilenti, Dorothy
  • Issel, L. Michele

Abstract

Throughout the United States, public health leaders are experimenting with how best to integrate services for individuals with complex needs. To that end, North Carolina implemented a policy incorporating both local public health departments and other providers into medical homes for low income pregnant women and young children at risk of developmental delays. To understand how this transition occurred within local communities, a pre-post comparative case study was conducted. A total of 42 people in four local health departments across the state were interviewed immediately before the 2011 policy change and six months later: 32 professionals (24 twice) and 10 pregnant women receiving case management at the time of the policy implementation. We used constant comparative analysis of interview and supplemental data to identify three key consequences of the policy implementation. One, having medical homes increased the centrality of other providers relative to local health departments. Two, a shift from focusing on personal relationships toward medical efficiency diverged in some respects from both case managers' and mothers' goals. Three, health department staff re-interpreted state policies to fit their public health values. Using a political economy perspective, these changes are interpreted as reflecting shifts in public health's broader ideological environment. To a large extent, the state successfully induced more connection between health department-based case managers and external providers. However, limited provider engagement may constrain the implementation of the envisioned medical homes. The increased focus on medical risk may also undermine health departments' role in supporting health over time by attenuating staff relationships with mothers. This study helps clarify how state public health policy innovations unfold at local levels, and why front line practice may in some respects diverge from policy intent.

Suggested Citation

  • Wells, Rebecca & Cilenti, Dorothy & Issel, L. Michele, 2015. "The political economy of a public health case management program's transition into medical homes," Social Science & Medicine, Elsevier, vol. 145(C), pages 98-106.
    • Handle: RePEc:eee:socmed:v:145:y:2015:i:c:p:98-106
    DOI: 10.1016/j.socscimed.2015.10.003
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953615301453
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2015.10.003?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. repec:mpr:mprres:6908 is not listed on IDEAS
    2. Matt E. Ryan, 2014. "Allocating Infection: The Political Economy Of The Swine Flu (H1n1) Vaccine," Economic Inquiry, Western Economic Association International, vol. 52(1), pages 138-154, January.
    3. Ahmed Mushfiq Mobarak & Andrew Sunil Rajkumar & Maureen Cropper, 2011. "The Political Economy of Health Services Provision in Brazil," Economic Development and Cultural Change, University of Chicago Press, vol. 59(4), pages 723-751.
    4. Buescher, P.A. & Roth, M.S. & Williams, D. & Goforth, C.M., 1991. "An evaluation of the impact of maternity care coordination on Medicaid birth outcomes in North Carolina," American Journal of Public Health, American Public Health Association, vol. 81(12), pages 1625-1629.
    5. Zakus, J. David L., 0. "Resource dependency and community participation in primary health care," Social Science & Medicine, Elsevier, vol. 46(4-5), pages 475-494, February.
    6. Moehling, Carolyn M. & Thomasson, Melissa A., 2012. "The Political Economy of Saving Mothers and Babies: The Politics of State Participation in the Sheppard-Towner Program," The Journal of Economic History, Cambridge University Press, vol. 72(1), pages 75-103, March.
    7. Schenck, A.P. & Meyer, A.M. & Kuo, T.-M. & Cilenti, D., 2015. "Building the evidence for decision-making: The relationship between local public health capacity and community mortality," American Journal of Public Health, American Public Health Association, vol. 105, pages 211-216.
    8. L. Michele Issel & Sarah G. Forrestal & Jaime Slaughter & Anna Wiencrot & Arden Handler, "undated". "A Review of Prenatal Home-Visiting Effectiveness for Improving Birth Outcomes," Mathematica Policy Research Reports dadf48a4556844ec95c362b14, Mathematica Policy Research.
    9. Pritchett, Lant, 2005. "The political economy of targeted safety nets," Social Protection Discussion Papers and Notes 31498, The World Bank.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Monika Köppl-Turyna, 2016. "Opportunistic politicians and fiscal outcomes: the curious case of Vorarlberg," Public Choice, Springer, vol. 168(3), pages 177-216, September.
    2. D. Mark Anderson & Ryan Brown & Kerwin Kofi Charles & Daniel I. Rees, 2016. "The Effect of Occupational Licensing on Consumer Welfare: Early Midwifery Laws and Maternal Mortality," NBER Working Papers 22456, National Bureau of Economic Research, Inc.
    3. repec:dau:papers:123456789/4334 is not listed on IDEAS
    4. Jonathan Fox & Mikko Myrskylä, 2015. "Urban fertility responses to local government programs: Evidence from the 1923-1932 U.S," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 32(16), pages 487-532.
    5. repec:ilo:ilowps:487627 is not listed on IDEAS
    6. Szklo, Michel & Clarke, Damian & Rocha, Rudi, 2024. "Does Increasing Public Spending in Health Improve Health? Lessons from a Constitutional Reform in Brazil," IZA Discussion Papers 16829, Institute of Labor Economics (IZA).
    7. Christophe Muller, 2007. "Anti-Poverty Transfers without Riots in Tunisia," Working Papers DT/2007/08, DIAL (Développement, Institutions et Mondialisation).
    8. Hoehn-Velasco, Lauren, 2018. "Explaining declines in US rural mortality, 1910–1933: The role of county health departments," Explorations in Economic History, Elsevier, vol. 70(C), pages 42-72.
    9. Jonathan Gruber, 1997. "Health Insurance for Poor Women and Children in the US: Lessons from the Past Decade," NBER Chapters, in: Tax Policy and the Economy, Volume 11, pages 169-211, National Bureau of Economic Research, Inc.
    10. Craig Sugden, 2009. "Responding to High Commodity Prices," Asian-Pacific Economic Literature, The Crawford School, The Australian National University, vol. 23(1), pages 79-105, May.
    11. Lauren Hoehn‐Velasco & Elizabeth Wrigley‐Field, 2022. "City health departments, public health expenditures, and urban mortality over 1910–1940," Economic Inquiry, Western Economic Association International, vol. 60(2), pages 929-953, April.
    12. Vinci, Vincenzo & Roelen, Keetie, 2018. "Institutional factors and people's preferences in the implementation of social protection: the case of Ethiopia," MERIT Working Papers 2018-017, United Nations University - Maastricht Economic and Social Research Institute on Innovation and Technology (MERIT).
    13. Jonathan F. Fox, 2011. "Public health, poor relief and improving urban child mortality outcomes in the decade prior to the New Deal," MPIDR Working Papers WP-2011-005, Max Planck Institute for Demographic Research, Rostock, Germany.
    14. Currie, Janet & Gruber, Jonathan, 1996. "Saving Babies: The Efficacy and Cost of Recent Changes in the Medicaid Eligibility of Pregnant Women," Journal of Political Economy, University of Chicago Press, vol. 104(6), pages 1263-1296, December.
    15. Jolley, G. Jason, 2023. "The Political Economy of Local Government Enterprise Zone Designation," Journal of Regional Analysis and Policy, Mid-Continent Regional Science Association, vol. 53(2), September.
    16. Lipscomb, Molly & Mobarak Mushfiq, Ahmed & Bahram, Tania, 2011. "Development effects of electrification: evidence from the geologic placement of hydropower plants in Brazil," Research Department working papers 218, CAF Development Bank Of Latinamerica.
    17. Andreas Kotsadam & Jo Thori Lind & Jørgen Modalsli, 2022. "Call the midwife. Health personnel and mortality in Norway 1887–1920," Cliometrica, Springer;Cliometric Society (Association Francaise de Cliométrie), vol. 16(2), pages 243-276, May.
    18. Nagano, Hitoshi & Puppim de Oliveira, Jose A. & Barros, Allan Kardec & Costa Junior, Altair da Silva, 2020. "The ‘Heart Kuznets Curve’? Understanding the relations between economic development and cardiac conditions," World Development, Elsevier, vol. 132(C).
    19. repec:phd:pjdevt:pjd_2007_vol__xxxiv_no__1-a is not listed on IDEAS
    20. Sam Hickey, 2007. "Conceptualising the Politics of Social Protection in Africa," Global Development Institute Working Paper Series 0407, GDI, The University of Manchester.
    21. Haseeb, Muhammad & Vyborny, Kate, 2022. "Data, discretion and institutional capacity: Evidence from cash transfers in Pakistan," Journal of Public Economics, Elsevier, vol. 206(C).
    22. Bernet, Patrick M. & Gumus, Gulcin & Vishwasrao, Sharmila, 2018. "Effectiveness of public health spending on infant mortality in Florida, 2001–2014," Social Science & Medicine, Elsevier, vol. 211(C), pages 31-38.
    23. Gruber, J. & Currie, J., 1994. "Saving Babies: The Efficacy and Cost of Recent Expansions of Medicaid Eligibility for Pregnant Women," Working papers 94-11, Massachusetts Institute of Technology (MIT), Department of Economics.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:145:y:2015:i:c:p:98-106. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.