The Policy Doctor

For those living in the United States, the last few years have been something of a crash-course in healthcare policy. Even with the Affordable Healthcare Act fully in effect, Americans are hardly well-versed in phrases like “single-payer,” “universal,” and “federal mandate.”
For international healthcare policy experts like Nicole Maddox ’02, twin sister of Natalie Maddox ’02, featured on page 48 however, making sure citizens get quality care is more than a partisan debate. Having worked in Zambia, Kenya, Arkansas, and now Milan, Maddox has an in-depth understanding of how national policies affect the real health of individual citizens.

“Healthcare policies are grounded by the healthcare issues in the country,” said Maddox. “In Africa, key concerns are HIV testing, malaria interventions, and access to medication. In the U.S. we’re interested in making sure everyone has health insurance and health coverage, and ensuring no one is exposed to secondhand smoke, as examples. The issues are different in Zambia.”

In Zambia, the majority of health services in the country are free to patients. Whether or not patients can access timely and quality services is another question, and one that policy analysts like Maddox are tasked with answering.

Maddox recalls one project in Kenya where she examined patient mortalities related to cervical cancer. “I was there for seven months, and I did a retrospective analysis looking back two years at the medical records of women who came for cancer services and a lot of them had died. The women were coming in the late stages of the disease, at the terminal stages, so there wasn’t much doctors could do.” Maddox said that her research showed that a number of the terminal patients had come to the clinic at stage one, but not returned until stage four.

According to Maddox, “At the time there was only one public facility that could perform radiation on women with cervical cancer. The wait time was generally six to eight months.” Using that data, the clinic Maddox worked with proposed opening new radiation centers to provide care more quickly and at more affordable rates.
Much of Maddox’s work involves stacks of patient files. “You wonder where that cartoon image of a government worker’s desk covered in files comes from?” she joked, speaking to her own time going through over 100 patient files, each with their own manila folder.

To Maddox, policy changes that would mandate digitizing patient files would make not only her research, but also the quality of care a patient receives, happen more efficiently. According to Maddox, in Kenya, “every time you go into the hospital they give you a new ID number so tracking specific patients is very hard.” This is why it took a special healthcare policy analyst to notice that patients who were arriving at stage three had previously visited the hospital at stage one.

While digitizing records is key to helping healthcare policy analysts conduct research to improve patient care, Maddox warns that governments (and consumers) also need to focus on the money. “One of the things you need to look at when you think about improving care is how much will this cost, and who will pay for it? Is it going to fall to the patient? Is it going to fall to the government? Is it going to fall to someone else?”

As a country, the United States is dealing with this issue first-hand. In implementing a new healthcare policy that will cover more citizens, cost is a factor—along with who will provide the funds. “We are just entering the era of having [federally mandated] healthcare in all 50 states and we don't quite understand what the cost will be on the government. It will be interesting to look at the data in five years to see how this has impacted the quality of life in the United States and to examine its financial benefits.”

It’s for this reason that Maddox has decided to go back to school. She’s currently a PhD candidate in public policy and administration at Università Commerciale 'Luigi Bocconi' in Milan. Previously, she earned her master’s degree in public service from the Clinton School of Public Service after her time at Wellesley College where she earned her bachelor’s degree in Africana studies and biology. She believes her PhD will give her the skills necessary to further analyze healthcare policy from an economic perspective.

Maddox’s interest in healthcare was heavily influenced by the death of her grandmother. “I’ve been passionate about working on issues involving cancer since I lost my grandmother at 13,” she said, continuing with the caveat, “If you asked me what I wanted to be at 13, well, I would have said a doctor.”

Though not at the operating table, Maddox is still influencing the lives of patients through research; her work ensures governments develop better, more comprehensive policies when it comes to health.

“I would say this has been a path of discovery. When I went to do my master’s in public service, we were required to do an international service project. I chose Kenya and I really fell in love with the country and the work I was able to do, and I knew this is where I needed to be,” said Maddox. “It’s been an amazing journey thus far.”
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