Out-of-pocket expenditures and the financial burden of healthcare among older adults: by nativity and length of residence in the United States

Determinants of the health care service choices of long-term mechanical ventilation patients: Applying andersen’s behavioral model

Aims

The number of ventilator-dependent patients is rapidly increasing globally. As a result, long-term mechanical ventilation (LTMV) patients face the choice of receiving health care in respiratory care wards (RCWs) rather than at home. In this study, we applied Andersen’s behavioral theoretical model (ABM) to investigate the determinants of the health care service decisions of patients receiving LTMV.

Methods

A cross-sectional research design and cluster random sampling were used to select 365 participants from nine RCWs and eight home care facilities in northern Taiwan. Data were collected in face-to-face interviews using a structured questionnaire.

Results

Of the predisposing factors, advanced age and an education level of at least junior high school influenced the choice to use RCW services. Being married, living with extended family, and medium or higher socioeconomic status were associated with the decision to use home care services. Of the enabling factors, patients with more caregivers, those whose family caregivers held strong beliefs about providing care, and those who perceived greater social support from health care providers were more likely to choose home care services. Of the need factors examined, poor cognitive function and higher dependence on assistance for activities of daily living (ADL) increased the probability of patients choosing RCW services. Hierarchical logistic regression analysis indicated that our final model accounted for 44.8% of the observed variance in health care service choice.

Conclusions

ABM enables an improved understanding of the health care service choices of LTMV patients. Our findings also highlight the importance of rigorously assessing patient needs and helping patients choose the most appropriate health care service.

Social Determinants of Health Assessment Tool: Implications for Healthcare Practice

Underserved populations are at risk for chronic health conditions due to social determinants. There is a gap in instrument availability in identifying individuals at risk of, or experiencing, cumulative social, environmental, economic, and cultural factors impacting health. The Social Determinants of Health Assessment Tool is a brief, cost-effective semistructured interview allowing healthcare professionals to engage in appropriate service prioritization. Phase I of this instrument development reported adequate face validity by Delphi panel consensus with experts in social work, nursing, public health, and psychology. This instrument identifies individuals at risk of social determinants to improve healthcare and social service delivery.

The reasons older immigrants in the United States of America report for returning to Mexico

Mexicans are the largest immigrant group in the United States and are ageing rapidly. Data support that many return to Mexico due to economic factors such as employment. Few studies have investigated if older immigrants return to Mexico for different reasons than younger immigrants. Using the Mexican Health and Aging Study (N=952), we examine whether Mexican immigrants in the United States who returned to Mexico at age 50 and older report different reasons for returning than those who returned at younger ages. Few immigrants (regardless of age) returned to Mexico for economic reasons. The most commonly reported reason for returning to Mexico for both groups was missing family. However, the odds of listing illness over missing family as their main reason for returning were higher for older immigrants than younger immigrants after controlling for duration in the United States and other sociodemographic factors (OR=0.27; 95% CI=0.11, 0.68). These results challenge existing theories of international migration which focus on employment considerations.

Medical Expenditures on and by Immigrant Populations in the United States: A Systematic Review

In health care policy debates, discussion centers around the often-misperceived costs of providing medical care to immigrants. This review seeks to compare health care expenditures of U.S. immigrants to those of U.S.-born individuals and evaluate the role which immigrants play in the rising cost of health care. We systematically examined all post-2000, peer-reviewed studies in PubMed related to health care expenditures by immigrants written in English in the United States. The reviewers extracted data independently using a standardized approach. Immigrants' overall expenditures were one-half to two-thirds those of U.S.-born individuals, across all assessed age groups, regardless of immigration status. Per capita expenditures from private and public insurance sources were lower for immigrants, particularly expenditures for undocumented immigrants. Immigrant individuals made larger out-of-pocket health care payments compared to U.S.-born individuals. Overall, immigrants almost certainly paid more toward medical expenses than they withdrew, providing a low-risk pool that subsidized the public and private health insurance markets. We conclude that insurance and medical care should be made more available to immigrants rather than less so.