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Xiong Y, Lin K, Yao Y, Zhong Z, Xiang L. Comparison of the market share of public and private hospitals under different Medical Alliances: an interrupted time-series analysis in rural China. BMC Health Serv Res 2024; 24:496. [PMID: 38649910 PMCID: PMC11034031 DOI: 10.1186/s12913-024-10941-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND China initiated the Medical Alliances (MAs) reform to enhance resource allocation efficiency and ensure equitable healthcare. In response to challenges posed by the predominance of public hospitals, the reform explores public-private partnerships within the MAs. Notably, private hospitals can now participate as either leading or member institutions. This study aims to evaluate the dynamic shifts in market share between public and private hospitals across diverse MAs models. METHODS Data spanning April 2017 to March 2019 for Dangyang County's MA and January 2018 to December 2019 for Qianjiang County's MA were analyzed. Interrupted periods occurred in April 2018 and January 2019. Using independent sample t-tests, chi-square tests, and interrupted time series analysis (ITSA), we compared the proportion of hospital revenue, the proportion of visits for treatment, and the average hospitalization days of discharged patients between leading public hospitals and leading private hospitals, as well as between member public hospitals and member private hospitals before and after the reform. RESULTS After the MAs reform, the revenue proportion decreased for leading public and private hospitals, while member hospitals saw an increase. However, ITSA revealed a notable rise trend in revenue proportion for leading private hospitals (p < 0.001), with a slope of 0.279% per month. Member public and private hospitals experienced decreasing revenue proportions, with outpatient visits proportions declining in member public hospitals by 0.089% per month (p < 0.05) and inpatient admissions proportions dropping in member private hospitals by 0.752% per month (p < 0.001). The average length of stay in member private hospitals increased by 0.321 days per month after the reform (p < 0.01). CONCLUSIONS This study underscores the imperative to reinforce oversight and constraints on leading hospitals, especially private leading hospitals, to curb the trend of diverting patients from member hospitals. At the same time, for private hospitals that are at a disadvantage in competition and may lead to unreasonable prolongation of hospital stay, this kind of behavior can be avoided by strengthening supervision or granting leadership.
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Affiliation(s)
- Yingbei Xiong
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030, Wuhan, China
| | - Kunhe Lin
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030, Wuhan, China
| | - Yifan Yao
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030, Wuhan, China
| | - Zhengdong Zhong
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030, Wuhan, China
| | - Li Xiang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030, Wuhan, China.
- HUST base of National Institute of healthcare Security, Wuhan, China.
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Permanent Contraception: Ethical Issues and Considerations: ACOG Committee Statement No. 8. Obstet Gynecol 2024; 143:e31-e39. [PMID: 38237165 DOI: 10.1097/aog.0000000000005474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Permanent contraception is the most used method of contraception among women aged 15-49 years and is one of the most straightforward surgical procedures an obstetrician-gynecologist can perform. At the same time, this therapeutic option is enormously complex when considered from a historical, sociological, or ethical perspective. This Committee Statement reviews ethical issues related to permanent contraception using a reproductive justice framework. Ethical counseling and shared decision making for permanent contraception should adopt a nonjudgmental, patient-centered approach, using up-to-date information about permanent contraception procedures and alternatives. Obstetrician-gynecologists should strive to avoid bringing into the clinical encounter biases around gender, race, age, and class that affect thoughts on who should or should not become a parent. Obstetrician-gynecologists should also ensure that permanent contraception requests reflect each patient's wishes, come from a desire to permanently end childbearing, and come from a preference for permanent contraception over all reversible methods as well as permanent contraception for the male partner. When difficulties in meeting a postpartum permanent contraception request are anticipated and permanent contraception is desired by the patient, transfer of care for the remainder of pregnancy should be offered. ACOG recognizes the right of all patients to unimpeded access to permanent contraception as a way of ensuring health equity, but it is unclear how to craft policies that protect from coercion but also do not create barriers to autonomously desired care. Determining the ethical balance between access and safeguards will require a collaborative interdisciplinary approach that involves a variety of stakeholders with varying perspectives.
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Temkin SM, Terplan M. Levels of Gynecologic Care: A Task Force Consensus Statement. Obstet Gynecol 2023; 142:993-994. [PMID: 37734102 DOI: 10.1097/aog.0000000000005363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
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Madison AM, Powers D, Maslowsky J, Goyal V. Association Between Publicly Funded Contraceptive Services and the Abortion Rate in Texas, 2010-2015. Obstet Gynecol 2023; 141:361-370. [PMID: 36649327 PMCID: PMC9858333 DOI: 10.1097/aog.0000000000005057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/20/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate how the availability of contraceptive services was associated with a change in the abortion rate before and after Texas' legislative changes to the family planning budget in 2011 and abortion access in 2013. METHODS In this cross-sectional study, we obtained 2010 and 2015 data on contraceptive provision (number of publicly funded clinics and number of contraceptive clients served per 1,000 reproductive-aged women) from the Guttmacher Institute and county-level abortion data from the Texas Department of State Health Services. We categorized counties as having an abortion rate that increased or declined less than the national rate between 2010 and 2015 ( low-decline counties ) compared with those having an abortion rate that declined equal to or greater than the national rate between 2010 and 2015 ( high-decline counties ). We evaluated differences in contraceptive provision between high-decline and low-decline counties and evaluated county characteristics (racial and ethnic composition, unemployment, poverty, uninsured, education, distance to an abortion clinic, deliveries covered by Medicaid, and Catholic hospital marketplace dominance) as potential confounders. RESULTS Of 157 counties that had at least one contraceptive clinic in either 2010 or 2015, 49 were low-decline counties and 108 were high-decline counties. Although the total number of publicly funded family planning clinics increased by 10.8%, there was a 4.7% decrease in the total number of contraceptive clients served statewide. Compared with low-decline counties, high-decline counties had a higher median number of contraceptive clients served per 1,000 women aged 18-44 years (31.9 vs 60.7, P <.05) in 2015. Between 2010 and 2015, the abortion rate decreased 19.7% for each 1.0% increase in contraceptive clients served. CONCLUSION Texas counties with higher abortion-rate declines had more publicly funded contraceptive clinics and served more contraceptive clients than counties with lower declines, which may indicate the importance of greater access to publicly funded contraceptive services.
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Affiliation(s)
- Anita M Madison
- Department of Obstetrics and Gynecology, Louisiana State University Health Science Center, Baton Rouge, Louisiana; the Population Research Center, University of Texas at Austin, Austin, Texas; and the School of Public Health, University of Illinois Chicago, Chicago, Illinois
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Merner B, Haining CM, Willmott L, Savulescu J, Keogh LA. Institutional objection to abortion: A mixed-methods narrative review. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231152373. [PMID: 36785871 PMCID: PMC10071095 DOI: 10.1177/17455057231152373] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Institutional objection (IO) occurs when institutions providing health care claim objector status and refuse to provide legally permissible health services such as abortion. IO may be regulated by sources including law, ethical codes and policies (including State and local/institutional policies). We conducted a mixed-methods narrative review of the empirical evidence exploring IO to abortion provision globally, to inform areas for further research. MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), Global Health (CAB Abstracts), ScienceDirect and Scopus were searched in August 2021 using keywords including 'conscientious objection', 'faith-based organizations', 'religious hospitals' and 'abortion'. Eligible research focused on clinicians' attitudes and experiences of IO to abortion. The 28 studies included in the review were from nine countries: United States (19), Chile (2), Turkey (1), Argentina (1), Australia (1), Colombia (1), Ghana (1), Poland (1) and South Africa (1). The analysis demonstrated that IO was claimed in a range of countries, despite different legislative and policy frameworks. There was strong evidence from the United States that clinicians in religious healthcare institutions were less likely to provide abortions and abortion referrals, and that training of future abortion providers was negatively affected by IO. Qualitative evidence from other countries showed that IO was claimed by secular as well as religious institutions, and individual conscientious objection could be used as a mechanism for imposing IO. Further research is needed to explore whether IO is morally justified, how decisions are made to claim IO, and on what grounds. Finally, appropriate models for regulating IO are needed to ensure the protection of women's access to abortion. Such models could be informed by those used to regulate IO in other contexts, such as voluntary assisted dying.
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Affiliation(s)
- Bronwen Merner
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Casey M Haining
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Lindy Willmott
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, QLD, Australia
| | - Julian Savulescu
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.,Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | - Louise A Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
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Catholic Perspective on Decision-Making for Critically Ill Newborns and Infants. CHILDREN 2022; 9:children9020207. [PMID: 35204927 PMCID: PMC8870660 DOI: 10.3390/children9020207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 11/17/2022]
Abstract
In this paper, we discuss the foundational values informing the Catholic perspective on decision-making for critically ill newborns and infants, particularly focusing on the prudent use of medical technologies. Although the Church has consistently affirmed the general good of advances in scientific research and medicine, the technocratic paradigm of medicine may, particularly in cases with severely ill infants, lead to decision-making conflicts and breakdowns in communication between parents and providers. By exploring two paradigm cases, we offer specific practices in which providers can engage to connect with parents and avoid common technologically mediated decision-making conflicts. By focusing on the inherent relationality of all human persons, regardless of debility, and the Christian hope in the life to come, we can make decisions in the midst of the technocratic paradigm without succumbing to it.
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Henkel A, Beshar I, Goldthwaite LM. Postpartum permanent contraception: updates on policy and access. Curr Opin Obstet Gynecol 2021; 33:445-452. [PMID: 34534995 DOI: 10.1097/gco.0000000000000750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To describe barriers to provision of postpartum permanent contraception at patient, hospital, and insurance levels. RECENT FINDINGS Permanent contraception remains the most commonly used form of contraception in the United States with the majority of procedures performed during birth-hospitalization. Many people live in regions with a high Catholic hospital market share where individual contraceptive plans may be refused based on religious doctrine. Obesity should not preclude an individual from receiving a postpartum tubal ligation as recent studies find that operative time is clinically similar with no increased risk of complications in obese compared with nonobese people. The largest barrier to provision of permanent contraception remains the federally mandated consent for sterilization for those with Medicaid insurance. State variation in enforcement of the Medicaid policy additionally contributes to unequal access and physician reimbursement. Although significant barriers exist in policy that will take time to improve, hospital-based interventions, such as listing postpartum tubal ligation as an 'urgent' procedure or scheduling interval laparoscopic salpingectomy prior to birth-hospitalization discharge can make a significant impact in actualization of desired permanent contraception for patients. SUMMARY Unfulfilled requests for permanent contraception result in higher rates of unintended pregnancies, loss of self-efficacy, and higher costs. Hospital and federal policy should protect vulnerable populations while not preventing provision of desired contraception.
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Affiliation(s)
- Andrea Henkel
- Division of Family Planning Services & Research, Department of Obstetrics & Gynecology, Stanford University, Stanford, California, USA
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Hebert LE, Wingo EE, Hasselbacher L, Schueler KE, Freedman LR, Stulberg DB. Reproductive healthcare denials among a privately insured population. Prev Med Rep 2021; 23:101450. [PMID: 34258172 PMCID: PMC8254036 DOI: 10.1016/j.pmedr.2021.101450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/08/2021] [Accepted: 04/30/2021] [Indexed: 11/03/2022] Open
Abstract
This study aimed to quantify and examine reproductive healthcare denials experienced by individuals receiving employer-sponsored health insurance. We conducted a national cross-sectional survey using probability and non-probability-based panels from December 2019-January 2020. Eligible respondents were adults employed by any Standard and Poor's 500 company, who received employer-sponsored health insurance. Respondents (n = 1,001) reported whether anyone on their healthcare plan had been denied a reproductive healthcare service in the past five years and details about their denials. We conducted bivariate analyses and multiple logistic regression to estimate factors associated with denials. Eleven percent of respondents (14% of women; 10% of men) reported a denial. Compared to lower-income respondents, those with income ≥ $50,000/year were less likely to experience a denial (aOR = 0.53; 95% CI 0.29-0.97). Compared to respondents who were never married, being married (aOR = 2.33; 95% CI: 1.03-5.30) or cohabiting (aOR = 2.43; 95% CI: 1.03-5.72) significantly increased odds of experiencing a denial. In 38% of cases the patient learned of the denial at a scheduled visit, while 23% learned in an emergency setting, and 13% after the encounter. Individuals covered by employer-sponsored health insurance continue to be denied coverage of preventive services. Employers and insurers can facilitate access to reproductive healthcare by ensuring that their plans include comprehensive coverage and in-network providers offer comprehensive services.
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Affiliation(s)
- Luciana E. Hebert
- Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA, USA
| | - Erin E. Wingo
- Department of Family and Community Medicine, University of California, San Francisco, 1701 Divisadero St, San Francisco, CA, USA
| | - Lee Hasselbacher
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, Department of Obstetrics and Gynecology, University of Chicago, 6030 South Ellis Avenue, Chicago IL, USA
| | - Kellie E. Schueler
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Ste #104, Chicago, IL, USA
| | - Lori R. Freedman
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, 1701 Divisadero St, San Francisco, CA, USA
- Advancing New Standards in Reproductive Health (ANSIRH), University of California San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, USA
| | - Debra B. Stulberg
- Department of Family Medicine, University of Chicago, 5841 S Maryland Ave., Chicago, IL, 60637, USA
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Redinger MJ, Eberl JT. New Developments in End-of-Life Teaching for Roman Catholic Healthcare: The Implications of Samaritanus Bonus ("The Good Samaritan"). Am J Hosp Palliat Care 2021; 39:501-503. [PMID: 34323125 DOI: 10.1177/10499091211034365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Michael J Redinger
- Department of Medical Ethics, Humanities and Law, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA.,Department of Psychiatry, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Jason T Eberl
- Gnaegi Center for Health Care Ethics, Saint Louis University, Saint Louis, MO, USA
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Kramer RD, Higgins JA, Burns ME, Freedman LR, Stulberg DB. Prevalence and experiences of Wisconsin women turned away from Catholic settings without receiving reproductive care. Contraception 2021; 104:377-382. [PMID: 34023379 DOI: 10.1016/j.contraception.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To estimate prevalence of being turned away from a Catholic healthcare setting without receiving desired reproductive care among Wisconsin women and to document firsthand accounts of these experiences. STUDY DESIGN Between October 2019 and April 2020, we fielded a two-stage survey to Wisconsin women aged 18-45, oversampling rural census tracts and rural counties served by Catholic sole community hospitals. We present prevalence of ever being turned away from a Catholic hospital or clinic without receiving desired contraceptive or fertility care and document accounts of referrals, perceived barriers, and wait times to acquire services elsewhere. RESULTS The screener response rate was 37.6% (N = 828) and the survey response rate was 83.4% (N = 675). While only 23 (2.0%) of Wisconsin women had ever been turned away from a Catholic hospital or clinic without receiving desired contraceptive or fertility care (95% confidence interval: 1.2%-3.5%), these experiences were more common among women in counties served by Catholic sole community hospitals (n = 9, 8.1% [4.0%-15.6%]) compared to women in other rural census tracts (n = 6, 2.8% [1.3%-6.2%]) and urban census tracts (n = 8, 1.5% [0.7%-3.2%]). Sixteen (69.6%) cited religious restrictions as a barrier to accessing care. Some women - especially those denied tubal ligation - experienced long delays in acquiring time-sensitive care elsewhere. CONCLUSIONS About 1-in-12 women in Wisconsin rural counties served by Catholic sole community hospitals reported ever being turned away from a Catholic healthcare setting without receiving desired reproductive care. After tubal ligation denials in Catholic facilities, many women faced long wait times to receive care elsewhere. IMPLICATIONS Wisconsin women in rural counties served by Catholic sole community hospitals were about three times more likely than urban women to have ever been turned away from a Catholic facility. As Catholic healthcare expands nationally, it will be increasingly important to better understand how healthcare prohibitions influence patients' lives.
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Affiliation(s)
- Renee D Kramer
- Department of Population Health Sciences, Collaborative for Reproductive Equity, University of Wisconsin-Madison, University of Wisconsin-Madison, Madison, WI United States; Department of Obstetrics and Gynecology, Department of Gender and Women's Studies, and Collaborative for Reproductive Health Equity, University of Wisconsin-Madison, Madison, WI, United States.
| | - Jenny A Higgins
- Department of Obstetrics and Gynecology, Department of Gender and Women's Studies, and Collaborative for Reproductive Health Equity, University of Wisconsin-Madison, Madison, WI, United States; Department of Population Health Sciences, University of Wisconsin-Madison, University of Wisconsin-Madison, Madison, WI, United States
| | - Marguerite E Burns
- Department of Population Health Sciences, University of Wisconsin-Madison, University of Wisconsin-Madison, Madison, WI, United States
| | - Lori R Freedman
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, Oakland, CA, United States
| | - Debra B Stulberg
- Department of Family Medicine, University of Chicago, IL, United States
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Schueler KE, Hebert LE, Wingo EE, Freedman LR, Stulberg DB. Denial of tubal ligation in religious hospitals: Consumer attitudes when insurance limits hospital choice. Contraception 2021; 104:194-201. [PMID: 33657425 DOI: 10.1016/j.contraception.2021.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/17/2021] [Accepted: 02/24/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Postpartum tubal ligation provides demonstrated benefits to women, but access to this procedure is threatened by restrictions at Catholic healthcare institutions. We aimed to understand how insured employees assign responsibility for postpartum sterilization denial and how it impacts their view of the quality of care provided. STUDY DESIGN We conducted a nationally representative, cross-sectional survey of employees at Standard and Poor's (S&P) 500 companies utilizing a dual panel drawn from Amerispeak, a probability-based research panel, and a non-probability panel. Respondents answered questions about a scenario of a woman denied a tubal ligation due to Catholic hospital policy when her employer-sponsored insurance provided no other hospital choices. Of 1113 eligible panel members, 1001 (90%) completed the survey. Weighted analysis accounted for complex survey design. RESULTS In response to the tubal ligation denial scenario, 42% of respondents rated hospital quality-of-care as poor or very poor. Sixty percent felt that something should have been done differently, with about half assigning responsibility to the religiously-affiliated hospital for not providing the procedure and half to the insurance company for not including secular hospitals in its network. Finding employers/insurance companies responsible was more common with higher education (RRR = 3.17; 95% CI: 1.58-6.33 some college; RRR = 4.26; 95% CI: 2.10-8.62 bachelor's or more) and less common among non-white respondents (RRR = 0.54; 95% CI: 0.31-0.97). Three quarters of respondents thought the employer should have intervened. CONCLUSIONS The majority of insured employees do not think women should be denied postpartum tubal ligation. They assign hospitals, insurers, and employers responsibility to remove barriers to care. IMPLICATIONS Most people who receive health insurance through a large employer disapprove of Catholic hospital restrictions when the patient's insurance restricts her hospital choice. To improve access to comprehensive reproductive care, employers and insurers should assure employees have in-network coverage of hospitals without religious restrictions.
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Affiliation(s)
- Kellie E Schueler
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Luciana E Hebert
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
| | - Erin E Wingo
- Department of Family and Community Medicine, University of California San Francisco, San Francisco General Hospital, San Francisco, CA, USA
| | - Lori R Freedman
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA; Advancing New Standards in Reproductive Health (ANSIRH), University of California San Francisco, Oakland, CA, USA
| | - Debra B Stulberg
- Department of Family Medicine, University of Chicago, Chicago, IL, USA.
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Wiebe E, Sum B, Kelly M, Hennawy M. Forced and chosen transfers for medical assistance in dying (MAiD) before and during the COVID 19 pandemic: A mixed methods study. DEATH STUDIES 2021; 46:2266-2272. [PMID: 33612090 DOI: 10.1080/07481187.2021.1888824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to describe the experience of people who transferred locations for MAiD. It used mixed methods with a chart review from one health authority and interviews with key informants across Canada. In the chart review, we found that of 444 MAiD deaths, 42 (9.5%) were forced to transfer due to the religious affiliation of the facility and 33 (7.4%) chose to transfer. In 23 interviews with 18 key informants we found that the most important theme was the suffering caused by forced transfers. COVID-19 restrictions led to fewer choices and more suffering.
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Affiliation(s)
- Ellen Wiebe
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Brian Sum
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Michaela Kelly
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Mirna Hennawy
- Department of Family Practice, University of British Columbia, Vancouver, Canada
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Sepper E, Nelson JD. Disestablishing Hospitals. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2021; 49:542-551. [PMID: 35006060 DOI: 10.1017/jme.2021.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We argue that concentration of power in religious hospitals threatens disestablishment values. When hospitals deny care for religious reasons, they dominate patients' bodies and convictions. Health law should - and to some extent already does - constrain such religious domination.
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Guiahi M, Sheeder J, Stulberg D. Patient perceptions of healthcare differences within Catholic facilities. Am J Obstet Gynecol 2021; 224:110-111. [PMID: 32971010 DOI: 10.1016/j.ajog.2020.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/07/2020] [Accepted: 09/18/2020] [Indexed: 11/25/2022]
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Admon LK, Villavicencio J. Catholic Hospitals, Patient Autonomy, and Sexual and Reproductive Health Care in the United States. JAMA Netw Open 2020; 3:e1920131. [PMID: 31995208 DOI: 10.1001/jamanetworkopen.2019.20131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lindsay K Admon
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
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