Prospects for expanding health insurance coverage

Does Medicaid improve utilization of medical and dental services and health outcomes for Medicaid-eligible children in the United States?

BACKGROUND

Data are lacking to support the contention that Medicaid services improve utilization of healthcare services and result in better health.

OBJECTIVE

To compare sociodemographic, utilization of healthcare services and health status characteristics among Medicaid-eligible children.

METHODS

The third National Health and Nutrition Examination Survey included 2821 children 2-16 years of age eligible for Medicaid. The main outcome measures are annual physician visit, annual dentist visit, general health status, oral health status, asthma (second most common childhood disease), dental caries (most common childhood disease), asthma treatment needs, and dental treatment needs. We quantified the association of these outcome measures with Medicaid insurance status and sociodemographic status using multiple logistic regression modeling, taking into account the complex survey design and sample weights.

RESULTS

Among Medicaid-eligible children, 27% were uninsured. Among uninsured Medicaid-eligible children, 62% had an annual physician visit, 32% had an annual dentist visit, 10% needed asthma treatment, and 57% needed dental treatment. Among insured Medicaid-eligible children, 81% had an annual physician visit, 39% had an annual dentist visit, 13% needed asthma treatment, and 42% needed dental treatment. After simultaneously taking into account other characteristics, uninsured Medicaid-eligible children were more likely to not have an annual physician visit (OR(NoMDvisit) = 2.21; 1.26-3.90), and to need dental treatment (OR(DentalNeed) = 1.57; 1.13-2.18).

CONCLUSIONS

This USA population-based study found disparities exist within Medicaid's services between utilization of dental and medical services. Medicaid insurance improved utilization of medical services, but did not improve the utilization of dental services. This suggests that Medicaid insurance does not improve access to dental services for poor children.

Use of cervical cancer screening among insured women: the extent of missed opportunities

The objective of the study is to identify opportunities to improve cervical cancer screening among privately insured women. From MedStat's Marketscan database, we identified 735,181 women aged 21-64 years who remained in the same insurance plan during the entire period of 2000-2002. We obtained the percentages of women who had a Papanicolaou (Pap)-test reimbursement claim and any health-related claim during the 3-year period. For women without a Pap-test claim, we obtained information about the frequency of insurance claims, type of health-care provider, and type of insurance plan in which the women were enrolled. The multivariate logistic regression model was used to identify factors independently associated with not having a Pap test. Of the total sample, in the 3-year period, 96% had at least one health insurance reimbursement claim and 69% had at least one claim for a Pap test. Approximately, 87% of the women who had no Pap-test claim had a health claim; 44% of such claims were from primary care providers. In the multiple logistic regression model, factors that were independently associated with having no Pap test were old age, being dependents of employees, and enrollment in comprehensive insurance plans. Efforts to increase the use of cervical cancer screening service should consider additional risk factors besides lack of insurance coverage. Concerted efforts by insurance and health-care providers are needed to improve adherence to the recommended cervical cancer screening guidelines, both by consumers and service providers.

Health inequity: the plight of uninsured children in a rural Alabama county and the plan to cure it

Many children in the United States do not have access to health insurance. Providing health insurance for children has been particularly challenging in rural America. This article describes and evaluates a local plan to provide access to health care for school children in a rural Alabama county. A triangulated methodology (personal interviews, ad hoc survey focus groups, US census and health fair data) was used in the evaluation. Gains were made in enrolling children despite some limitations, especially in rural outreach. The most successful aspect of the program was a partnership between local leaders, health providers, and educators to provide impetus for a coordinated plan. The stability of the program is uncertain because of diminishing resources and the negative effects of economic recession.

Health programs in faith-based organizations: are they effective?

OBJECTIVES

We examined the published literature on health programs in faith-based organizations to determine the effectiveness of these programs.

METHODS

We conducted a systematic literature review of articles describing faith-based health activities. Articles (n = 386) were screened for eligibility (n = 105), whether a faith-based health program was described (n = 53), and whether program effects were reported (28).

RESULTS

Most programs focused on primary prevention (50.9%), general health maintenance (25.5%), cardiovascular health (20.7%), or cancer (18.9%). Significant effects reported included reductions in cholesterol and blood pressure levels, weight, and disease symptoms and increases in the use of mammography and breast self-examination.

CONCLUSIONS

Faith-based programs can improve health outcomes. Means are needed for increasing the frequency with which such programs are evaluated and the results of these evaluations are disseminated.

Urologists on a tightrope--do we have a net?

PURPOSE

The purpose of this review is to analyze the current health care environment and its impact on urological practice.

MATERIALS AND METHODS

The medical and lay literature as it pertains to the socioeconomics of health care was reviewed.

RESULTS

Analysis of the political and economic factors that influence the delivery of health care today reveals alarming realities. More than 40 million Americans remain uninsured, and with a retrenched economy that number is likely to increase. Neither government nor the private sector has been either willing or able to address the health care problem in a coherent or comprehensive way. As the population ages, the Medicare and Medicaid programs will become further stressed. Employers are increasingly unwilling to finance the health care expenses of their employees. Academic medical centers are facing unique exigencies that, if left uncorrected, will jeopardize the future training of physicians.

CONCLUSIONS

In the current environment of a depressed economy, further proposed tax cuts and increased military spending it appears inevitable that the economic restraints on medical care will increase substantially in the foreseeable future.

Health care in America: lost opportunities amid plenty

Despite frequent breakthroughs in medicine, and in the face of an expenditure on health that is almost twice that of any other country in the world, there are significant problems with health care in the United States. Fundamental failings reflect the underuse, overuse, and misuse of resources, which result in inadequate care for important medical conditions. An apparent blind faith in the benefits of science and technology may help account for these startling inadequacies, as lavish funding of the biomedical research effort diverts attention from the fundamental matter of delivering care for common diseases. With a shift in research priorities, the United States could shape a health care system that is far more responsive to the needs of its people.

Receiving money for medicine: some tensions and resolutions for community-based private complementary therapists

During recent years, private complementary medicine has grown as a significant provider of healthcare in the UK and much of this provision is through small private businesses financed by out-of-pocket payments made by privately paying clients. Using a combined questionnaire (n = 426) and interview survey (n = 49), the present paper considers the potential tensions and dilemmas which therapists face and the resolutions which they come to in being carers, but in market terms, also profit makers. Therapists generally identified with being carers first and business people second, and this was reflected in their caring decisions. Indeed, under circumstances where the roles potentially conflicted (e.g. when clients could no longer afford to pay for their treatments), most therapists claimed that they continued to provide care, either by providing their services free-of-charge, at a reduced rate, by deferring payment or by accepting alternative forms of compensation. There is a relative lack of dedicated research literature on complementary therapists, their attitudes and actions, and this paper provides some important data on their specific management and caring decisions. At the same time, the evidence also provides some initial food-for-thought and indicates some potential research directions for exploring ethical issues in the private practice of complementary medicine.