Evidenced Based Policy Decisions & Population Health: Policies,Disparities,and Data Integrity

The surfeit of health policy research in the health care literature is concomitant with the dearth in the public administration literature, although billions of public dollars are spent annually on healthcare. The purpose of this paper is to shed light on a critical flaw in our ability to accurately analyze the contributions of efficient and effective healthcare practitioners who hold the potential to substantially improve health care equity in the United States. Developing adequate primary care workforce capacity may depend on modernizing state regulatory policies. However, this decision must be based on clear evidence. Evidence related to service delivery and health outcomes for the US’ most vulnerable groups relies on the availability of valid, reliable, quality data. The Centers for Medicare and Medicaid database is the most logical and comprehensive data source. Yet, this intergovernmental and privatized program presents significant data obstacles. In seeking to analyze health policies using Medicaid data, significant data quality concerns emerged. Specifically, nurse practitioner and physician assistant services were under-represented in the datasets analyzed. This underestimates their true contributions to primary care and subsequently impairs our ability to analyze the true cost of primary care service delivery. Why is this important? In an era of healthcare transitions and changing reimbursement mechanisms, the ability to conduct valid investigations into Medicaid services is necessary to accurately inform regulatory and programmatic policy analysis and reform. Improvements in Medicaid data collection will contribute to improving data integrity, thus enabling better evidence based solutions for addressing crippling healthcare fiscal challenges. This study contributes three key findings, the adaptation of a model for data integrity in public administration, and concludes with making three recommendations for improving the utilization and reporting of critical evidence on which to base future health policy.