1
|
Nguyen OT, Nguyen D, Hong YR, Alishahi Tabriz A, Turner K. Telehealth Use Among People with Vision Impairments: Evidence from the 2020-2022 National Health Interview Survey. J Gen Intern Med 2024; 39:1084-1086. [PMID: 38308158 DOI: 10.1007/s11606-024-08662-5] [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] [Received: 01/02/2024] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Affiliation(s)
- Oliver T Nguyen
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
- Department of Industrial and Systems Engineering, University of Wisconsin at Madison, Madison, WI, USA.
| | - Dang Nguyen
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, USA
| | - Young-Rock Hong
- Department of Health Services Research, Management, and Policy, Gainesville, FL, USA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Oncologic Science, University of South Florida, Tampa, FL, USA
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Kea Turner
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Oncologic Science, University of South Florida, Tampa, FL, USA
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| |
Collapse
|
2
|
Park S, Stimpson JP. Unmet need for medical care among Medicare beneficiaries by health insurance literacy and disability. Disabil Health J 2024; 17:101548. [PMID: 37980229 DOI: 10.1016/j.dhjo.2023.101548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/27/2023] [Accepted: 11/01/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Navigating the US healthcare system requires considerable health insurance literacy, especially for adults with disabilities. Limited health insurance literacy may lead to suboptimal treatment, leading to unmet need for medical care. OBJECTIVE We examined whether unmet need for medical care among Medicare beneficiaries differs by health insurance literacy and disability status. METHODS Using data from the 2010-2019 Medicare Current Beneficiary Survey, we identified 48,989 Medicare beneficiaries, including those in traditional Medicare and Medicare Advantage. Our outcomes were three measures of unmet need for medical care. Our key independent variables were health insurance literacy and disability status. For each outcome, we estimated the adjusted rates of reporting unmet need for medical care by health insurance literacy and disability while controlling for individual-level characteristics. RESULTS Unmet need for medical care was higher among Medicare beneficiaries with disabilities across all outcomes, but the highest rates were among those with disabilities and limited health insurance literacy (27.4% [95% CI: 24.9-29.9] for experiencing delayed care, 17.7% [95% CI: 15.6-19.9] for experiencing trouble in getting needed care, and 20.8% [95% CI: 18.5-23.1] for not seeing a doctor despite medical need). Notably, there was an increasing trend in experiencing delayed care and trouble getting needed care among Medicare beneficiaries with disabilities over time, especially for those with limited health insurance literacy. CONCLUSIONS Medicare beneficiaries with disabilities and limited health insurance literacy face disproportionate unmet need for medical care. Policies are needed to ensure that these beneficiaries have access to clear and accessible health insurance information.
Collapse
Affiliation(s)
- Sungchul Park
- Department of Health Policy and Management, College of Health Science, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841 , Republic of Korea; BK21 FOUR R&E Center for Learning Health Systems, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
| | - Jim P Stimpson
- Peter O'Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States
| |
Collapse
|
3
|
Dong X, Miller NA. The Effects of Medicaid Expansion Under the Affordable Care Act on Health Insurance Coverage, Health Care Access, and Health Care Use for People With Disabilities: A Scoping Review. JOURNAL OF DISABILITY POLICY STUDIES 2022. [DOI: 10.1177/10442073221118124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
More than 27% of individuals in the U.S. experience a disability. We conducted a scoping review of the literature to examine what is known about the impact of the 2010 Affordable Care Act Medicaid expansion on individuals with disabilities’ health care insurance coverage, health care access, and health care use. We followed the approach of Arskey and O’Malley in conducting our review. Electronic journal databases, hand searching of key health and disability journals, and reference checking were used to identify potential articles for the review. Individuals with disabilities or with conditions that could be disabling were included. The intervention used was the 2010 Affordable Care Act Medicaid expansion. Study eligibility criteria were peer-reviewed studies published in 2014 or later that conducted multivariate analyses of the effect of the Medicaid expansion on people with disabilities’ health insurance coverage, health care access, and health care use. The most consistent finding across studies was that the Medicaid expansion had a positive effect on health insurance coverage. It was generally found to have increased Medicaid coverage and decreased the uninsured rate. Its effect on private or employer-sponsored insurance coverage was a mix of no and negative effects. Findings related to health care access and use of care were more mixed. On a scale of 0 to 8 (highest quality), the quality of individual studies ranged from 2 to 6, with an average across studies of 4.2, the low end of adequate quality. Future studies should develop a more consistent approach to measuring disability and develop a core set of health care access and use measures to facilitate comparisons across studies so as to systematically evaluate the evidence related to the Medicaid expansion.
Collapse
|
4
|
Aguillard K, Hughes R, Gemeinhardt GL, Schick V, McCurdy S. "They Didn't Ask." Rural Women With Disabilities and Experiences of Violence Describe Interactions With the Healthcare System. QUALITATIVE HEALTH RESEARCH 2022; 32:656-669. [PMID: 34978225 DOI: 10.1177/10497323211059142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Women with disabilities are at risk of experiencing multiple forms of severe and prolonged violence, yet guidelines for screening this population are unclear, screening rates are historically low, and screening tools may be inadequate to capture disability-related aspects of abuse. We conducted qualitative in-depth interviews with 33 rural women in the United States with diverse disabilities and experiences of violence. They described overarching healthcare provider and system factors that influenced their trust and confidence in healthcare delivery as an avenue to support their safety. Women described interactions with the healthcare system during their experience of violence as a missed opportunity for identifying and responding to their abuse and connecting them with resources. We conclude with policy and practice recommendations based on women with disabilities' perspectives and insights.
Collapse
Affiliation(s)
| | | | | | - Vanessa Schick
- 12340University of Texas School of Public Health, Houston, TX, USA
| | - Sheryl McCurdy
- 12340University of Texas School of Public Health, Houston, TX, USA
| |
Collapse
|
5
|
Rachev B, Uyei J, Singh R, Kowal S, Johnson CE. Stakeholder point of view on prescription drug affordability - a systematic literature review and content analysis. Health Policy 2021; 125:1158-1165. [PMID: 34281700 DOI: 10.1016/j.healthpol.2021.06.013] [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: 11/09/2020] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The objectives of this research were to: 1) understand perspectives on affordability of pharmaceutical drugs from the point of view of stakeholders as reported in published peer-reviewed journals and conferences; 2) evaluate if (and how) perspectives on affordability overlapped across stakeholders. METHODS The systematic literature review followed Cochrane and PRISMA guidelines. Content analysis with iterative and systematic coding of text was conducted, to identify themes. RESULTS A total of 7,372 unique citations were eligible, and 126 articles included for final synthesis. For patients, 6 core themes emerged: financial barriers, adherence, access, patient-provider communication, financial distress, and factors that impact affordability. For payers, 5 core themes: financing schemes, cost-effectiveness, budget impact, private vs. public preferences, and ethics. For providers, 3 themes: patient-provider communication, physician prescribing behavior, and finding alternatives to support patient access. For policymakers, 2 themes: measuring affordability and the role of government. Limited articles representing the manufacturer perspective were identified. Perspectives of decision makers (payers, policymakers) did not overlap with those affected by affordability (patients, providers). CONCLUSIONS This research highlights the multi-dimensionality of drug "affordability." Multiple factors beyond cost influence patient affordability implying interventions can help alleviate affordability issues for some patients. The lack of overlap highlights potential hazards that decisions related to out-of-pocket spending, insurance coverage, reimbursement, and rationing occur without explicitly considering patient and provider perspectives.
Collapse
Affiliation(s)
| | - Jennifer Uyei
- Principal, Health Economics and Outcomes Research, IQVIA Inc., San Francisco, CA, USA
| | - Rajpal Singh
- Senior Consultant, Health Economics and Outcomes Research, IQVIA Inc., Mumbai, India
| | - Stacey Kowal
- Practice Leader, Health Economics and Outcomes Research, IQVIA Inc., Falls Church, VA, USA
| | - C Erwin Johnson
- Director, Policy Evidence Research CORE, Merck & Co. Inc., Kenilworth, NJ, USA.
| |
Collapse
|
6
|
Insaf TZ, Sommerhalter KM, Jaff TA, Farr SL, Downing KF, Zaidi AN, Lui GK, Van Zutphen AR. Access to cardiac surgery centers for cardiac and non-cardiac hospitalizations in adolescents and adults with congenital heart defects- a descriptive case series study. Am Heart J 2021; 236:22-36. [PMID: 33636136 PMCID: PMC8097661 DOI: 10.1016/j.ahj.2021.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/19/2021] [Indexed: 01/14/2023]
Abstract
Background Individuals with congenital heart defects (CHDs) are recommended to receive all inpatient cardiac and noncardiac care at facilities that can offer specialized care. We describe geographic accessibility to such centers in New York State and determine several factors associated with receiving care there. Methods We used inpatient hospitalization data from the Statewide Planning and Research Cooperative System (SPARCS) in New York State 2008–2013. In the absence of specific adult CHD care center designations during our study period, we identified pediatric/adult and adult-only cardiac surgery centers through the Cardiac Surgery Reporting System to estimate age-based specialized care. We calculated one-way drive and public transit time (in minutes) from residential address to centers using R gmapsdistance package and the Google Maps Distance Application Programming Interface (API). We calculated prevalence ratios using modified Poisson regression with model-based standard errors, fit with generalized estimating equations clustered at the hospital level and subclustered at the individual level. Results Individuals with CHDs were more likely to seek care at pediatric/adult or adult-only cardiac surgery centers if they had severe CHDs, private health insurance, higher severity of illness at encounter, a surgical procedure, cardiac encounter, and shorter drive time. These findings can be used to increase care receipt (especially for noncardiac care) at pediatric/adult or adult-only cardiac surgery centers, identify areas with limited access, and reduce disparities in access to specialized care among this high-risk population.
Collapse
Affiliation(s)
- Tabassum Z Insaf
- Center for Environmental Health, New York State Department of Health, Albany, NY; School of Public Health, University at Albany, Albany, NY
| | | | - Treeva A Jaff
- Center for Environmental Health, New York State Department of Health, Albany, NY; School of Public Health, University at Albany, Albany, NY
| | - Sherry L Farr
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Ali N Zaidi
- Adult Congenital Heart Disease Center, Mount Sinai Heart/Icahn School of Medicine at Mount Sinai, New York, NY
| | - George K Lui
- Stanford University School of Medicine, Stanford, CA
| | - Alissa R Van Zutphen
- Center for Environmental Health, New York State Department of Health, Albany, NY; School of Public Health, University at Albany, Albany, NY
| |
Collapse
|
7
|
Access to care and health insurance coverage for workers with disabilities: Outcomes by state-level responses to the ACA. Disabil Health J 2021; 14:101099. [PMID: 33879404 DOI: 10.1016/j.dhjo.2021.101099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND States had flexibility in their implementation of the Patient Protection and Affordable Care Act (ACA) Medicaid expansions, which may have led to variation in coverage and changes in access to care for workers with disabilities. OBJECTIVE/HYPOTHESIS To examine differential trends in health insurance coverage and access to care among workers with disabilities by states' decisions about expanding Medicaid under the ACA. METHODS We aggregated data from the National Health Interview Survey into groups by time period relative to ACA implementation: pre-ACA (2006-2009), early ACA (2010-2013), and later ACA (2014-2017). We produced health insurance and access statistics for each time period, by state-level Medicaid expansion status. RESULTS Uninsurance rates decreased after 2014 in all states, regardless of the state's decision whether to expand Medicaid. There was a substantial increase after 2014 in the share of workers with disabilities covered by Medicaid in states that expanded in that year; in other states, workers with disabilities experienced larger increases in privately purchased coverage. At the same time, the share of workers with disabilities reporting cost-related barriers to care declined markedly in 2014 Medicaid expansion states, but it increased slightly in the non-expansion states. Structural barriers to accessing care increased in all states, with the smallest increase in 2014 expansion states. CONCLUSIONS Medicaid coverage and cost-related access to care improved significantly among workers with disabilities in 2014 Medicaid expansion states, both overall and relative to workers with disabilities in non-expansion states.
Collapse
|
8
|
Hall JP, Batza K, Streed CG, Boyd BA, Kurth NK. Health Disparities Among Sexual and Gender Minorities with Autism Spectrum Disorder. J Autism Dev Disord 2020; 50:3071-3077. [PMID: 32056117 DOI: 10.1007/s10803-020-04399-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We explored the health and health care experiences of people with autism spectrum disorder (ASD) who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ+) using data from a national, internet-based survey of adults with disabilities supplemented by focused interviews. LGBTQ+ respondents had significantly higher rates of mental illness, poor physical health days per month, and smoking compared to straight, cisgender respondents with ASD. LGBTQ+ respondents also reported much higher rates of unmet health care need, inadequate insurance provider networks, and rates of being refused services by a medical provider. Examining the intersection of LGBTQ+ identity and ASD reveals compounded health disparities that insurers and medical providers are not adequately addressing, particularly as individuals transition to the adult medical system.
Collapse
Affiliation(s)
- Jean P Hall
- Institute for Health & Disability Policy Studies, University of Kansas, 1000 Sunnyside Ave, Lawrence, KS, 66045, USA. .,Department of Applied Behavioral Science, University of Kansas, Lawrence, KS, USA.
| | - Katie Batza
- Department of Women, Gender and Sexuality Studies, University of Kansas, 318 Blake Hall, 1541 Lilac Lane, Lawrence, KS, 66045, USA
| | - Carl G Streed
- Boston University School of Medicine, 72 East Concord St, Boston, MA, 02118, USA.,Center for Transgender Medicine & Surgery, Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA
| | - Brian A Boyd
- Department of Applied Behavioral Science, University of Kansas, Lawrence, KS, USA.,Juniper Gardens Children's Project, University of Kansas Life Span Institute, 444 Minnesota Ave, Ste 300, Kansas City, KS, 666101, USA
| | - Noelle K Kurth
- Institute for Health & Disability Policy Studies, University of Kansas, 1000 Sunnyside Ave, Lawrence, KS, 66045, USA
| |
Collapse
|
9
|
Smith SD, Hall JP, Kurth NK. Perspectives on Health Policy From People With Disabilities. JOURNAL OF DISABILITY POLICY STUDIES 2020. [DOI: 10.1177/1044207320956679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
People with disabilities are marginalized and face barriers to participation in society, including political participation and representation. While data indicate that people with disabilities have similar political preferences to the overall U.S. population, little research has been conducted to assess the health policy views of people with disabilities in their own words. This study uses qualitative data collected between 2017 and 2019 via 35 telephone interviews and 484 open-ended responses from a nationally representative survey to analyze what people with disabilities would like policymakers to know about health care and health insurance for people with disabilities. Results reveal that this population’s perceptions of social exclusion and stigma inform what they would like to tell policymakers. In addition, people with disabilities were largely supportive of Affordable Care Act features and framed expanded or universal access to health care as a human right or a moral issue.
Collapse
|
10
|
Sevak P, Schimmel Hyde J. The ACA Medicaid Expansions and Employment of Adults With Disabilities. JOURNAL OF DISABILITY POLICY STUDIES 2020. [DOI: 10.1177/1044207320943554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Patient Protection and Affordable Care Act (ACA) of 2010 substantially expanded the availability of health insurance coverage, particularly for adults with disabilities. One notable change was the option for states to offer Medicaid coverage to adults with household incomes that were below 138% of the federal poverty line; most but not all states expanded Medicaid to this population. This article investigates whether states that expanded Medicaid coverage through the ACA in 2014—the first year that expansion was possible under the ACA, and the year that most states opted to expand—experienced differential changes in the employment rate of adults with disabilities relative to states that did not expand Medicaid. Using nationally representative data from the American Community Survey, we do not find evidence that the postexpansion employment trend in Medicaid expansion states was significantly different from that trend in states that did not expand Medicaid.
Collapse
Affiliation(s)
- Purvi Sevak
- Mathematica Policy Research, Princeton, NJ, USA
| | | |
Collapse
|
11
|
Health care access and the Americans with Disabilities Act: A mixed methods study. Disabil Health J 2020; 14:100967. [PMID: 32768336 DOI: 10.1016/j.dhjo.2020.100967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 06/07/2020] [Accepted: 06/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Americans with Disabilities Act (ADA) requires that health care entities provide full and equal access to people with disabilities. However, results of previous studies have indicated that the ADA has been largely ineffective at creating systemic change in the delivery of health care. OBJECTIVE The objective of this study was to examine the current barriers to health care access experienced by people with disabilities under Titles II and III of the ADA. METHODS This study utilized a mixed methods multiphase design. In phase one, a survey and focus groups were conducted with individuals with disabilities who experienced barriers to health care access. In phase two, key informant interviews were conducted with individuals who had a role in ensuring equal access to health care for people with disabilities. RESULTS In the current context of health care reform, people with disabilities continue to experience multiple barriers to health care access under Titles II and III of the ADA. However, a notable result is that several provisions of the Patient Protection and Affordable Care Act (ACA) have likely bolstered existing directives implementing requirements for health care access under the ADA. CONCLUSIONS The results of this study provide additional support for a comprehensive examination of both the national standards for accessible health care and the enforcement of laws that prohibit discrimination on the basis of disability.
Collapse
|
12
|
Hill A, Schimmel Hyde J. Insurance coverage and access to care for workers with disabilities, 2001-2017. Disabil Health J 2019; 13:100843. [PMID: 31648915 DOI: 10.1016/j.dhjo.2019.100843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Workers with disabilities have different options than their peers for obtaining health insurance, and face unique barriers in accessing care. The Patient Protection and Affordable Care Act (ACA) led to sweeping changes in the availability and affordability of health insurance in the United States beginning in 2010, and may have had important effects for workers with disabilities. OBJECTIVE/HYPOTHESIS Document how the ACA changed insurance coverage and access to care for workers with disabilities, and compare those changes to changes among other groups. METHODS We document health insurance coverage and access to care among workers with disabilities using the 2001-2017 National Health Interview Survey. RESULTS The share of insured workers with disabilities increased from 79.9% in 2009 to 87.8% in 2017. This gain resulted from an 11 percentage point (pp) increase in the share with Medicaid coverage in 2014-2017 compared with 2001-2009 and a 5 pp increase in privately purchased coverage over those periods. These were accompanied by an 11 pp decline in the share with employer-sponsored coverage. Despite coverage gains, cost-related barriers to accessing medical care did not change much after the ACA, for any group. Workers with disabilities experienced an increase in structural access barriers, from 18.4% before the ACA to 24.8% after. CONCLUSIONS The gain in insurance coverage for workers with disabilities is an important benefit of the ACA, but more investigation and monitoring should be considered to understand whether such coverage will translate into improvements in access to needed health care.
Collapse
Affiliation(s)
- Anna Hill
- Mathematica Policy Research, 955 Massachusetts Avenue, Suite 801, Cambridge, MA, 02139, USA.
| | - Jody Schimmel Hyde
- Mathematica Policy Research, 1100 First Street NE, 12th Floor, Washington, DC, 20002, USA.
| |
Collapse
|
13
|
Hall JP, Kurth NK. A Comparison of Health Disparities Among Americans With Intellectual Disability and/or Autism Spectrum Disorder and Americans With Other Disabilities. ACTA ACUST UNITED AC 2019. [DOI: 10.1352/2326-6988-7.3.160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Abstract
This article uses recent survey data to compare and contrast American adults with intellectual disability (ID) and/or autism spectrum disorder (ASD) and those with other disabilities with regard to overall health, access to health care, and other aspects of community participation. Although people with ID and/or ASD and others with disabilities share many issues related to poorer health and access to care compared to the general population, adults with ID and/or ASD reported different experiences and outcomes than other people with disabilities. An examination of these differences provides insights into policy changes and targeted interventions that might improve overall health and community inclusion specifically for people with ID and/or ASD.
Collapse
Affiliation(s)
- Jean P. Hall
- Jean P. Hall and Noelle K. Kurth, University of Kansas, Institute for Health and Disability Policy Studies
| | - Noelle K. Kurth
- Jean P. Hall and Noelle K. Kurth, University of Kansas, Institute for Health and Disability Policy Studies
| |
Collapse
|
14
|
|