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Bin Abdul Baten R, Noman A, Rahman MN. Affordable Care Act Medicaid expansion, access to health care, and financial behavior of the United States adults. J Public Health Policy 2024:10.1057/s41271-024-00522-0. [PMID: 39313587 DOI: 10.1057/s41271-024-00522-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2024] [Indexed: 09/25/2024]
Abstract
The access to care benefits of Affordable Care Act (ACA) Medicaid expansions are important for 45-64-year-old adults who are living below 100% of the Federal Poverty Level, a particularly vulnerable group in the United States (US). Gaining coverage from Medicaid expansions should improve access to healthcare and affect social determinants of health, including financial behavior. We analyzed data from 2009 to 2018 from the National Financial Capability Survey (NFCS) and utilize a difference-in-differences model to compare outcomes changes in states with and without expansion before and after the ACA Medicaid expansions. Overall, Medicaid expansion was associated with increased healthcare access for 45-64-year-olds, potentially resulting in better healthcare experience. Results indicate effects of the Medicaid expansion on the financial behavior of 45-64-year-olds, with evidence of credit card bills being paid in full, higher banking activities, and better financial preparedness. These findings have important implications for financial regulators and healthcare policymakers.
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Affiliation(s)
- Redwan Bin Abdul Baten
- Department of Health Management and Policy, College of Health and Human Services, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, 28223, USA.
| | - Abdullah Noman
- Thomas College of Business and Economics, University of North Carolina at Pembroke, Pembroke, NC, 28372, USA
| | - Mohammad Nakibur Rahman
- Thomas College of Business and Economics, University of North Carolina at Pembroke, Pembroke, NC, 28372, USA
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2
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Du C, Katz B, Shrestha P, Hori K, Dave G. Health Care Access and Cognitive Function in Older Adults: A Cross-Lagged Panel Longitudinal Analysis. J Appl Gerontol 2024; 43:1060-1068. [PMID: 38321751 DOI: 10.1177/07334648241230015] [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] [Indexed: 02/08/2024] Open
Abstract
Objective: The current longitudinal study examined how (1) cognitive measures, including episodic memory, executive function, and global cognition, predict later healthcare access and how (2) healthcare access predicts later cognition. Methods: Drawing a sample (n = 9920) from the Health and Retirement Study dataset, we created a cross-lagged panel model to examine the longitudinal association between cognitive measures and healthcare access from 2012 to 2018. Results: Results revealed that cognitive measures significantly predict later healthcare access, with effects increasing across waves. However, within sub-domains, memory was more predictive of later healthcare access over time compared to executive function. Discussions: Our study suggested an increased link between cognition and healthcare access during aging. Even outside of the context of AD, there are likely both policy-based and practical implications to ensure those experiencing cognitive decline continue to maintain access to care.
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Affiliation(s)
- Chenguang Du
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Benjamin Katz
- Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | | | - Kazuki Hori
- Benesse Educational Research and Development Institute, Tokyo, Japan
| | - Gaurav Dave
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Amjad S, Tromburg C, Adesunkanmi M, Mawa J, Mahbub N, Campbell S, Chari R, Rowe BH, Ospina MB. Social Determinants of Health and Pediatric Emergency Department Outcomes: A Systematic Review and Meta-Analysis of Observational Studies. Ann Emerg Med 2024; 83:291-313. [PMID: 38069966 DOI: 10.1016/j.annemergmed.2023.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 10/03/2023] [Accepted: 10/20/2023] [Indexed: 03/24/2024]
Abstract
STUDY OBJECTIVE Social determinants of health contribute to disparities in pediatric health and health care. Our objective was to synthesize and evaluate the evidence on the association between social determinants of health and emergency department (ED) outcomes in pediatric populations. METHODS This review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity Extension guidelines. Observational epidemiological studies were included if they examined at least 1 social determinant of health from the PROGRESS-Plus framework in relation to ED outcomes among children <18 years old. Effect direction plots were used for narrative results and pooled odds ratios (pOR) with 95% confidence intervals (CI) for meta-analyses. RESULTS Fifty-eight studies were included, involving 17,275,090 children and 103,296,839 ED visits. Race/ethnicity and socioeconomic status were the most reported social determinants of health (71% each). Black children had 3 times the odds of utilizing the ED (pOR 3.16, 95% CI 2.46 to 4.08), whereas visits by Indigenous children increased the odds of departure prior to completion of care (pOR 1.58, 95% CI 1.39 to 1.80) compared to White children. Public insurance, low income, neighborhood deprivation, and proximity to an ED were also predictors of ED utilization. Children whose caregivers had a preferred language other than English had longer length of stay and increased hospital admission. CONCLUSION Social determinants of health, particularly race, socioeconomic deprivation, proximity to an ED, and language, play important roles in ED care-seeking patterns of children and families. Increased utilization of ED services by children from racial minority and lower socioeconomic status groups may reflect barriers to health insurance and access to health care, including primary and subspecialty care, and/or poorer overall health, necessitating ED care. An intersectional approach is needed to better understand the trajectories of disparities in pediatric ED outcomes and to develop, implement, and evaluate future policies.
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Affiliation(s)
- Sana Amjad
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Courtney Tromburg
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Adesunkanmi
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Jannatul Mawa
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Nazif Mahbub
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Sandra Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Radha Chari
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Brian H Rowe
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Maria B Ospina
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada; Department of Public Health Sciences, Queen's University; Kingston, Ontario, Canada.
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Miao C, Fang X, Sun H, Yin Y, Li B, Shen W, Chen J, Huang X. The relationship between individual-level socioeconomic status and preference for medical service in primary health institutions: a cross-sectional study in Jiangsu, China. Front Public Health 2024; 11:1302523. [PMID: 38274517 PMCID: PMC10809986 DOI: 10.3389/fpubh.2023.1302523] [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: 09/26/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Background While China's primary health care (PHC) system covers all citizens, the use of medical services supplied by primary health institutions (PHIs) is not at ideal levels. This study explored the impact of socioeconomic status (SES) on residents' first choice of medical services provided by PHIs. Methods This community-based, cross-sectional study was conducted in Jiangsu Province, China, from October 2021 to March 2022. A custom-designed questionnaire was used to evaluate 4,257 adults, of whom 1,417 chose to visit a doctor when they were sick. Logistic regression was used to test the relationships among SES, other variables and the choice of medical services, and interaction effects were explored. Results A total of 1,417 subjects were included in this study (48.7% female; mean age 44.41 ± 17.1 years). The results showed that older age (p < 0.01), rural residence (p < 0.01), a preference for part-time medical experts in PHIs (p < 0.01), and lack of coverage by basic medical insurance (p < 0.05) were associated with the first choice to use PHIs. In the multiple logistic regression model, SES was not associated with the first choice of medical services supplied by PHIs (p > 0.05), but it interacted with three variables from the Commission on Social Determinants of Health Framework (material circumstances, behaviors and biological factors, and psychosocial factors). Conclusion Vulnerable individuals who are the target visitors to PHIs are older, live in rural areas, and suffer from chronic diseases. SES, as a single factor, did not impact whether medical services at PHIs were preferred, but it mediated relationships with other factors.
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Affiliation(s)
- Chunxia Miao
- School of Management, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xin Fang
- School of Management, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Hong Sun
- School of Economics and Management, Nanjing Forestry University, Nanjing, Jiangsu, China
| | - Yani Yin
- Personnel Department, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Bo Li
- School of Management, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wenxing Shen
- School of Economics and Management, Nanjing Forestry University, Nanjing, Jiangsu, China
| | - Jie Chen
- Nursing Department, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaojing Huang
- School of Management, Xuzhou Medical University, Xuzhou, Jiangsu, China
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Cha J, Nguyen HB, Salinas KE, Kamran SC. See, seek, support: a policy framework to uplift first-generation low-income medical professionals. J Public Health Policy 2023; 44:685-694. [PMID: 37884675 DOI: 10.1057/s41271-023-00445-2] [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] [Accepted: 09/19/2023] [Indexed: 10/28/2023]
Abstract
The First-Generation and/or Low-Income (FGLI) identity is not readily visible, encapsulating those who are the first in their families to complete a 4-year college degree and/or those living near or below the poverty line. In the backdrop of unprecedented levels of socioeconomic inequality in a country where household income predicts educational attainment, we explore the current state of U.S. society regarding socioeconomic status and health care. We describe challenges in diversifying the health care workforce and present a multi-pronged policy approach for visibilizing, recruiting, supporting, and retaining FGLI trainees in medicine, with the promise of improving the quality of health care delivery altogether. Through this work, we aim to render the field of medicine more equitable for trainees, physicians, and patients alike.
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Affiliation(s)
| | | | | | - Sophia C Kamran
- Harvard Medical School, Boston, MA, USA.
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
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Salinas KE, Nguyen HB, Kamran SC. The invisible minority: A call to address the persistent socioeconomic diversity gap in U.S. medical schools and the physician workforce. Front Public Health 2022; 10:924746. [PMID: 35968485 PMCID: PMC9372571 DOI: 10.3389/fpubh.2022.924746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Sophia C. Kamran
- Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States
- *Correspondence: Sophia C. Kamran
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Bin Abdul Baten R, Wehby GL. Effects of the 2014 Affordable Care Act Medicaid Expansions on Health Care Access and Health Status of Poor Adults Aged 60-64 Years: Evidence From the First 6 Years. THE GERONTOLOGIST 2022; 62:923-930. [PMID: 34940880 PMCID: PMC9290902 DOI: 10.1093/geront/gnab189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Little is known on the effects of the Affordable Care Act (ACA) Medicaid expansions on health care access and health status of adults closest to 65. This study examines the effects of ACA Medicaid expansion on access and health status of poor adults aged 60-64 years. RESEARCH DESIGN AND METHODS The study employs a difference-in-differences design comparing states that expanded Medicaid in 2014 under the ACA and nonexpansion states over 6 years postexpansion. The data are from the 2011-2019 Behavioral Risk Factor Surveillance System for individuals aged 60-64 years below the Federal Poverty Level. RESULTS Having any health care coverage rate increased by 8.5 percentage points (p < .01), while the rate of forgoing a needed doctor's visit due to cost declined by 6.6 percentage points (p < .01). Similarly, rates of having a personal doctor/provider and completing a routine checkup increased by 9.1 (p < .01) and 4.8 (p < .1) percentage points, respectively. Moreover, days not in good physical health in the past 30 declined by 1.5 days (p < .05), with suggestive evidence for decline in days not in good mental health and improvement in self-rated health. DISCUSSION AND IMPLICATIONS The ACA Medicaid expansions have improved health care access and health status of poor adults aged 60-64 years. Expanding Medicaid in the states that have not yet done so would reduce barriers to care and address unmet health needs for this population. Bridging coverage for individuals aged 60-64 years by lowering Medicare eligibility age could have long-term effects on well-being and health services utilization.
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Affiliation(s)
- Redwan Bin Abdul Baten
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - George L Wehby
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa, USA
- National Bureau of Economic Research, Cambridge, Massachusetts, USA
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Tipirneni R, Ayanian JZ. Spillover Benefits of Medicaid Expansion for Older Adults With Low Incomes. JAMA HEALTH FORUM 2022; 3:e221389. [DOI: 10.1001/jamahealthforum.2022.1389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Renuka Tipirneni
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - John Z. Ayanian
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Editor in Chief, JAMA Health Forum
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Oselio B, Singal AG, Zhang X, Van T, Liu B, Zhu J, Waljee AK. Reinforcement learning evaluation of treatment policies for patients with hepatitis C virus. BMC Med Inform Decis Mak 2022; 22:63. [PMID: 35272662 PMCID: PMC8913329 DOI: 10.1186/s12911-022-01789-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evaluation of new treatment policies is often costly and challenging in complex conditions, such as hepatitis C virus (HCV) treatment, or in limited-resource settings. We sought to identify hypothetical policies for HCV treatment that could best balance the prevention of cirrhosis while preserving resources (financial or otherwise). METHODS The cohort consisted of 3792 HCV-infected patients without a history of cirrhosis or hepatocellular carcinoma at baseline from the national Veterans Health Administration from 2015 to 2019. To estimate the efficacy of hypothetical treatment policies, we utilized historical data and reinforcement learning to allow for greater flexibility when constructing new HCV treatment strategies. We tested and compared four new treatment policies: a simple stepwise policy based on Aspartate Aminotransferase to Platelet Ratio Index (APRI), a logistic regression based on APRI, a logistic regression on multiple longitudinal and demographic indicators that were prespecified for clinical significance, and a treatment policy based on a risk model developed for HCV infection. RESULTS The risk-based hypothetical treatment policy achieved the lowest overall risk with a score of 0.016 (90% CI 0.016, 0.019) while treating the most high-risk (346.4 ± 1.4) and the fewest low-risk (361.0 ± 20.1) patients. Compared to hypothetical treatment policies that treated approximately the same number of patients (1843.7 vs. 1914.4 patients), the risk-based policy had more untreated time per patient (7968.4 vs. 7742.9 patient visits), signaling cost reduction for the healthcare system. CONCLUSIONS Off-policy evaluation strategies are useful to evaluate hypothetical treatment policies without implementation. If a quality risk model is available, risk-based treatment strategies can reduce overall risk and prioritize patients while reducing healthcare system costs.
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Affiliation(s)
- Brandon Oselio
- Department of Biostatistics, University of Michigan, Ann Arbor, MI USA
| | - Amit G. Singal
- Department of Internal Medicine, Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX USA
| | - Xuefei Zhang
- Department of Statistics, University of Michigan, Ann Arbor, MI USA
| | - Tony Van
- Health Services Research and Development Center of Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Gastroenterology 111D, Ann Arbor, MI 48105 USA
| | - Boang Liu
- Department of Statistics, University of Michigan, Ann Arbor, MI USA
- Googleplex, 1600 Amphitheatre Parkway, Mountainview, CA USA
| | - Ji Zhu
- Department of Statistics, University of Michigan, Ann Arbor, MI USA
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, MI USA
| | - Akbar K. Waljee
- Health Services Research and Development Center of Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Gastroenterology 111D, Ann Arbor, MI 48105 USA
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, MI USA
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI USA
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Simning A, Caprio TV, Li Y, Conwell Y. Near Vision but not Hearing Loss is Associated with Lacking a Usual Source of Health Care. J Aging Health 2021; 33:786-797. [PMID: 33914652 DOI: 10.1177/08982643211014323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Sensory loss may be a barrier to accessing healthcare services, and this study seeks to examine the association of sensory loss with whether older adults report having a usual source of health care. Methods: Our study included 7548 older adults who participated in the National Health and Aging Trends Study in 2015. Having a self-reported usual source of health care was our outcome, and hearing and vision loss were our primary independent variables. Results: In multivariate analysis accounting for demographics, socioeconomic, health status, and environmental covariates, near vision loss but not distance vision or hearing loss was associated with decreased odds of having a usual source of health care. Discussion: That older adults with near vision loss were less likely to report having a usual source of health care is concerning. Examining barriers to care is needed to identify sensory loss-relevant processes to optimize and intervene upon.
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Affiliation(s)
- Adam Simning
- Department of Psychiatry, 6927University of Rochester, NY, USA.,Department of Public Health Sciences, 6927University of Rochester, NY, USA
| | - Thomas V Caprio
- Department of Psychiatry, 6927University of Rochester, NY, USA.,Department of Public Health Sciences, 6927University of Rochester, NY, USA.,Division of Geriatrics, Department of Medicine, 6927University of Rochester, NY, USA
| | - Yue Li
- Department of Public Health Sciences, 6927University of Rochester, NY, USA
| | - Yeates Conwell
- Department of Psychiatry, 6927University of Rochester, NY, USA.,Office for Aging Research and Health Services, 6927University of Rochester, NY, USA
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