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Lu J, Dong Y, Zhang X, Wang Y, Zhou Z. The relationship between public risk preference and the underuse or overuse of preventive health services in the information age. Prev Med Rep 2024; 41:102727. [PMID: 38633208 PMCID: PMC11021990 DOI: 10.1016/j.pmedr.2024.102727] [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: 05/31/2023] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/19/2024] Open
Abstract
The underuse or overuse of preventive health services by individuals is an outward behavioural reflection of their attitude towards disease risk, and they are strongly influenced by their information-acquisition ability. Therefore, we try to explore the relationship among the public risk preference, information-acquisition ability and underuse or overuse of preventive health services, in order to provide decision-making basis in the Information Age. The survey surveyed 2,211 respondents aged ≥ 18 in China from September to December 2019. Taking cancer screening as an example, the multiple price list (MPL) test and item response theory (IRT) model were used to measure individual risk preference and information-acquisition ability. The Logit model and Tobit model were used to estimate the relationship between risk preference, information-acquisition ability and underuse or overuse of preventive health services. Risk-seeking individuals were more likely to underuse preventive health services, while risk-averse individuals were more likely to overuse such services. Information-acquisition ability may improve the underuse of preventive health services in risk-seeking individuals but exacerbate the overuse of preventive health services in risk-averse individuals. Among the investigated information channels, the Internet is the most effective way for the public to obtain information. It is necessary to change the public's incorrect perception of disease risks and risks associated with preventive health services. In the rapid development of the Information Age, improving public information-acquisition ability is a practicable way to correct the negative relationship between risk preference and individuals' underuse or overuse of preventive health services.
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Affiliation(s)
- Jiao Lu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yanan Dong
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xiaoxiao Zhang
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yuan Wang
- School of Management, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
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Nijhof K, Boot FH, Naaldenberg J, Leusink GL, Bevelander KE. Health support of people with intellectual disability and the crucial role of support workers. BMC Health Serv Res 2024; 24:4. [PMID: 38167137 PMCID: PMC10763292 DOI: 10.1186/s12913-023-10206-2] [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] [Received: 06/02/2023] [Accepted: 10/24/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND People with intellectual disability have a poorer health status than the general population. In The Netherlands, support workers play a key role in meeting health support needs of people with intellectual disability. Research on how people with intellectual disability and their support workers experience the support worker's role in preventing, identifying, and following up health needs of people with intellectual disability is scarce. To enhance health support of people with intellectual disability it is crucial that we understand how health support is delivered in everyday practice. Therefore, this study investigated experiences of people with intellectual disability and support workers with the health support of people with intellectual disability. METHOD Data collection consisted of six focus group (FG) discussions with between four and six participants (N = 27). The FGs consisted of three groups with support workers (n = 15), two groups with participants with mild to moderate intellectual disability (n = 8), and one group with family members as proxy informants who represented their relative with severe to profound intellectual disability (n = 4). The data was analysed thematically on aspects relating to health support. RESULTS We identified three main themes relevant to the health support of people with intellectual disability: 1) dependence on health support, 2) communication practices in health support, and 3) organizational context of health support. Dependence on health support adresses the way in which support workers meet a need that people with intellectual disability cannot meet themselves, and communication practices and organizational context are identified as systems in which health support takes place. CONCLUSION This study investigated experiences with the health support of people with intellectual disability from the perspectives of people with intellectual disability and support workers. We discuss the dependence of people with intellectual disability and the complexity of health support in everyday practice. We provide practical implications that can strengthen support workers in the provision of health support for people with intellectual disability in everyday practice. The findings of this study emphasize the need for intellectual disability care-provider organizations to establish policies around consistency in support staff to make it easier to identify and follow up health needs, and an environment where support staff can develop their expertise concerning communication practices, lifestyle choices, and identifying and following up health needs.
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Affiliation(s)
- Kim Nijhof
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
- Academic collaborative Intellectual Disability and Health - Sterker op Eigen Benen (SOEB), Nijmegen, The Netherlands.
| | - Fleur H Boot
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
- Academic collaborative Intellectual Disability and Health - Sterker op Eigen Benen (SOEB), Nijmegen, The Netherlands.
| | - Jenneken Naaldenberg
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Academic collaborative Intellectual Disability and Health - Sterker op Eigen Benen (SOEB), Nijmegen, The Netherlands
| | - Geraline L Leusink
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Academic collaborative Intellectual Disability and Health - Sterker op Eigen Benen (SOEB), Nijmegen, The Netherlands
| | - Kirsten E Bevelander
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Academic collaborative Intellectual Disability and Health - Sterker op Eigen Benen (SOEB), Nijmegen, The Netherlands
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Vo A, Tao Y, Li Y, Albarrak A. The Association Between Social Determinants of Health and Population Health Outcomes: Ecological Analysis. JMIR Public Health Surveill 2023; 9:e44070. [PMID: 36989028 PMCID: PMC10131773 DOI: 10.2196/44070] [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: 11/04/2022] [Revised: 12/21/2022] [Accepted: 02/23/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND With the increased availability of data, a growing number of studies have been conducted to address the impact of social determinants of health (SDOH) factors on population health outcomes. However, such an impact is either examined at the county level or the state level in the United States. The results of analysis at lower administrative levels would be useful for local policy makers to make informed health policy decisions. OBJECTIVE This study aimed to investigate the ecological association between SDOH factors and population health outcomes at the census tract level and the city level. The findings of this study can be applied to support local policy makers in efforts to improve population health, enhance the quality of care, and reduce health inequity. METHODS This ecological analysis was conducted based on 29,126 census tracts in 499 cities across all 50 states in the United States. These cities were grouped into 5 categories based on their population density and political affiliation. Feature selection was applied to reduce the number of SDOH variables from 148 to 9. A linear mixed-effects model was then applied to account for the fixed effect and random effects of SDOH variables at both the census tract level and the city level. RESULTS The finding reveals that all 9 selected SDOH variables had a statistically significant impact on population health outcomes for ≥2 city groups classified by population density and political affiliation; however, the magnitude of the impact varied among the different groups. The results also show that 4 SDOH risk factors, namely, asthma, kidney disease, smoking, and food stamps, significantly affect population health outcomes in all groups (P<.01 or P<.001). The group differences in health outcomes for the 4 factors were further assessed using a predictive margin analysis. CONCLUSIONS The analysis reveals that population density and political affiliation are effective delineations for separating how the SDOH affects health outcomes. In addition, different SDOH risk factors have varied effects on health outcomes among different city groups but similar effects within city groups. Our study has 2 policy implications. First, cities in different groups should prioritize different resources for SDOH risk mitigation to maximize health outcomes. Second, cities in the same group can share knowledge and enable more effective SDOH-enabled policy transfers for population health.
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Affiliation(s)
- Ace Vo
- Information Systems and Business Analytics Department, Loyola Marymount University, Los Angeles, CA, United States
| | - Youyou Tao
- Information Systems and Business Analytics Department, Loyola Marymount University, Los Angeles, CA, United States
| | - Yan Li
- Center for Information Systems and Technology, Claremont Graduate University, Claremont, CA, United States
| | - Abdulaziz Albarrak
- Information Systems Department, King Faisal University, Al-Ahsa, Saudi Arabia
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4
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The impact of paid sick leave mandates on Women's health. Soc Sci Med 2023; 323:115839. [PMID: 36989657 DOI: 10.1016/j.socscimed.2023.115839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/18/2023]
Abstract
The United States does not have a national program to provide job-protected paid leave to workers when they or a family member are ill or need to seek medical care. Many workers receive paid sick leave through their employers, but women, particularly parents, those without a college degree, and Latinas, are less likely than their counterparts to receive employer-provided paid sick leave (PSL). To address the shortfall in PSL coverage, several states and localities have passed laws mandating employers to provide PSL. I examine the impacts of three recent state-level paid sick leave policies on women's self-reported health using data from the Behavior Risk Factor Surveillance System. Using static and event-study difference-in-differences models, I find that PSL mandates decreased the proportion of women reporting fair or poor health by an average of 2.4 percentage points and reduced the number of days women reported their physical and mental health was not good by 0.68 days and 0.43 days in the past 30 days respectively. Effects were concentrated among parents, women without college degrees, and women of color. This study demonstrates that despite being a low-intensity policy, PSL improves women's health and well-being and that mandating workplace benefits may play a role in achieving health equity.
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Siapno AED, Gaither TW, Tandel MD, Kwan L, Meng YY, Connor SE, Maliski SL, Fink A, George S, Litwin MS. Impact of Comprehensive Health Insurance on Quality of Life in Low-Income Hispanic Men with Prostate Cancer. Urology 2023; 172:89-96. [PMID: 36400270 DOI: 10.1016/j.urology.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/24/2022] [Accepted: 11/02/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effect of the transition from IMPACT, a disease-focused treatment program, to comprehensive health insurance under Medicaid through the Affordable Care Act (ACA) on general and prostate cancer-specific quality of life (QoL) on a cohort of previously uninsured low-income men. We hypothesize that general QoL would improve and prostate cancer-specific QoL would remain the same after the transition to comprehensive health insurance. METHODS We assessed and compared general QoL using the RAND SF-12v2™ (12-Item Short Form Survey, version 2) and prostate cancer-specific QoL using the UCLA PCI (Prostate Cancer Index) one year before, at, and one year after the transition between 30 men who transitioned to comprehensive insurance (newly insured/Medicaid group) and 54 men who remained in the prostate cancer program (uninsured/IMPACT group). We assessed the independent effects of Medicaid coverage on QoL outcomes using repeated-measures regression. RESULTS Our cohort was composed primarily of Hispanic men (82%). At transition, patient demographics and clinical characteristics were similar between the groups. General and prostate cancer-specific QoL did not differ between the groups and remained stable over time, Radical prostatectomy as primary treatment and shorter time since treatment were associated with worse urinary and sexual function across both groups and over all three time points. CONCLUSION Those who transitioned to full-scope insurance and those who remained in the free prostate cancer-focused treatment program had stable general and prostate cancer-specific QoL. High-touch navigation aspects of a disease-focused program may have contributed to stability in outcomes.
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Affiliation(s)
- Allen Enrique D Siapno
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA.
| | - Thomas W Gaither
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Megha D Tandel
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, CA
| | - Lorna Kwan
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Ying-Ying Meng
- Center for Health Policy Research, University of California, Los Angeles, CA
| | - Sarah E Connor
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | | | - Arlene Fink
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA; Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA
| | - Sheba George
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA; Department of Preventive and Social Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA
| | - Mark S Litwin
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA; Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA
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Qian Z, Chen X, Pucheril D, Al Khatib K, Lucas M, Nguyen DD, McNabb-Baltar J, Lipsitz SR, Melnitchouk N, Cole AP, Trinh QD. Long-Term Impact of Medicaid Expansion on Colorectal Cancer Screening in Its Targeted Population. Dig Dis Sci 2023; 68:1780-1790. [PMID: 36600118 PMCID: PMC9812352 DOI: 10.1007/s10620-022-07797-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/14/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Colorectal cancer screening continuously decreased its mortality and incidence. In 2010, the Affordable Care Act extended Medicaid eligibility to low-income and childless adults. Some states elected to adopt Medicaid at different times while others chose not to. Past studies on the effects of Medicaid expansion on colorectal cancer screening showed equivocal results based on short-term data following expansion. AIMS To examine the long-term impact of Medicaid expansion on colorectal cancer screening among its targeted population at its decade mark. METHODS Behavioral Risk Factor Surveillance System data were extracted for childless adults below 138% federal poverty level in states with different Medicaid expansion statuses from 2012 to 2020. States were stratified into very early expansion states, early expansion states, late expansion states, and non-expansion states. Colorectal cancer screening prevalence was determined for eligible respondents. Difference-in-differences analyses were used to examine the effect of Medicaid expansion on colorectal cancer screening in states with different expansion statuses. RESULTS Colorectal cancer screening prevalence in very early, early, late, and non-expansion states all increased during the study period (40.45% vs. 48.14%, 47.52% vs 61.06%, 46.06% vs 58.92%, and 43.44% vs 56.70%). Difference-in-differences analysis showed significantly increased CRC screening prevalence in very early expansion states during 2016 compared to non-expansion states (Crude difference-in-differences + 16.45%, p = 0.02, Adjusted difference-in-differences + 15.9%, p = 0.03). No statistical significance was observed among other years and groups. CONCLUSIONS Colorectal cancer screening increased between 2012 and 2020 in all states regardless of expansion status. However, Medicaid expansion is not associated with long-term increased colorectal cancer screening prevalence.
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Affiliation(s)
- Zhiyu Qian
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA ,Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Xi Chen
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Daniel Pucheril
- Department of Surgery, Booshoft School of Medicine, Wright State University, Dayton, OH USA
| | - Khalid Al Khatib
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA ,Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Mayra Lucas
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - David-Dan Nguyen
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Julia McNabb-Baltar
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Stuart R. Lipsitz
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Nelya Melnitchouk
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA ,Division of General and Gastrointestinal Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Alexander P. Cole
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA ,Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA ,Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
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Zhao J, Zheng Z, Nogueira L, Yabroff KR, Han X. Preexisting Condition Protections Under the Affordable Care Act: Changes in Insurance Coverage, Premium Contributions, and Out-of-Pocket Spending. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1360-1370. [PMID: 35304035 DOI: 10.1016/j.jval.2022.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 12/01/2021] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES In January 2014, the Affordable Care Act (ACA) preexisting condition protections prohibited coverage denials, premium increases, and claim denials on the basis of preexisting conditions. This study aimed to examine changes in coverage and premiums and out-of-pocket spending after the implementation of the preexisting condition protections under the ACA. METHODS We identified adults aged 18 to 64 years with (n = 59 041) and without preexisting conditions (n = 61 970) from the 2011-2013 and 2015-2017 Medical Expenditure Panel Survey. We used a difference-in-differences and a difference-in-difference-in-differences approach to assess the associations of preexisting condition protections and changes in insurance coverage, premium contributions, and out-of-pocket spending after the ACA. Simple and multivariable logistic or multivariable 2-part models were fitted for the full sample and stratified by family income (low ≤138% federal poverty level [FPL]; middle 139%-400% FPL; and high > 400 FPL). RESULTS The ACA increased nongroup insurance coverage to a similar extent for individuals with or without preexisting conditions at all income levels. Decreases in premium contributions were observed to a similar extent among families with nongroup private coverage regardless of declinable preexisting condition status, whereas no significant changes were observed among families with group coverage. We found greater decreases in out-of-pocket spending for individuals with preexisting conditions than those without conditions among both individuals covered by nongroup and group insurance, and a greater difference was observed among those covered by nongroup insurance (difference-in-difference-in-differences -$279; 95% confidence interval -$528 to -$29). CONCLUSIONS The ACA protections were associated with decreases in out-of-pocket spending among adults with preexisting conditions.
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Affiliation(s)
- Jingxuan Zhao
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA.
| | - Zhiyuan Zheng
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Leticia Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
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Abstract
BACKGROUND There were large differences across subgroups of adults in preventive services utilization before 2010. The Affordable Care Act had numerous provisions aimed at increasing utilization as well as at reducing disparities. OBJECTIVE This study examines whether preventive services utilization changed over time, across subgroups of adults defined by race/ethnicity, insurance coverage, poverty status, Census region, and urbanicity. METHODS Data from the Medical Expenditure Panel Survey Household Component are used to examine service utilization before the passage of the Affordable Care Act (2008/2009), after the implementation of the preventive services mandate and the dependent coverage provision (2012/2013), and after Medicaid expansions (2015/2016). Four preventive services are examined for adults aged 19-64-general checkups, blood cholesterol screening, mammograms, and colorectal cancer screening. Multivariate logistic regression models are used to predict preventive services utilization of adult subgroups in each time period, and to examine how differences across subgroups changed between 2008/2009 and 2015/2016. RESULTS There were modest increases in utilization between 2008/2009 and 2015/2016 for blood cholesterol and colorectal cancer screenings. For 3 of 4 preventive services, differences between the Northeast and the Midwest regions narrowed. However, large gaps in utilization across income groups and between those with and without coverage persisted. Disparities across racial/ethnic groups in general checkups persisted over time as well. CONCLUSION While some differences have narrowed, large gaps in preventive service utilization across population subgroups remain.
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Affiliation(s)
- Salam Abdus
- Agency for Healthcare Research and Quality, Department of Health and Human Services, Center for Financing, Access, and Cost Trends, Division of Research and Modeling, Rockville, MD
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Hoagland A, Shafer P. Out-of-pocket costs for preventive care persist almost a decade after the Affordable Care Act. Prev Med 2021; 150:106690. [PMID: 34144061 DOI: 10.1016/j.ypmed.2021.106690] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/10/2021] [Accepted: 06/13/2021] [Indexed: 10/21/2022]
Abstract
Higher cost-sharing reduces the amount of high-value health care that patients use, such as preventive care. Despite a sharp reduction in out-of-pocket (OOP) costs for preventive care after the implementation of the Affordable Care Act (ACA), patients often still get unexpected bills after receiving preventive services. We examined out-of-pocket costs for preventive care in 2018, almost ten years after the implementation of the ACA. We quantify the excess cost burden on a national scale using a partial identification approach and explore how this burden varies geographically and across preventive services. We found that in addition to premium costs meant to cover preventive care, Americans with employer-sponsored insurance were still charged between $75 million and $219 million in total for services that ought to be free to them ($0.50 to $1.40 per ESI-covered individual and $0.75 to $2.17 per ESI-covered individual using preventive care). However, some enrollees still faced OOP costs for eligible preventive services ranging into the hundreds of dollars. OOP costs are most likely to be incurred for women's services (e.g., contraception) and basic screenings (e.g., diabetes and cholesterol screenings), and by patients in the South or in rural areas.
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Affiliation(s)
- Alex Hoagland
- Department of Economics, College of Arts and Sciences, Boston University, USA.
| | - Paul Shafer
- Department of Health Law, Policy, and Management, School of Public Health, Boston University,USA
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10
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Norris HC, Richardson HM, Benoit MAC, Shrosbree B, Smith JE, Fendrick AM. Utilization Impact of Cost-Sharing Elimination for Preventive Care Services: A Rapid Review. Med Care Res Rev 2021; 79:175-197. [PMID: 34157906 DOI: 10.1177/10775587211027372] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Consumer cost-sharing has been shown to diminish utilization of preventive services. Recent efforts, including provisions within the Affordable Care Act, have sought to increase use of preventive care through elimination of cost-sharing for clinically indicated services. We conducted a rapid review of the literature to determine the impact of cost-share elimination on utilization of preventive services. Searches were conducted in PubMed, Scopus, and CINAHL Complete databases as well as in grey literature. A total of 35 articles were included in qualitative synthesis and findings were summarized for three clinical service categories: cancer screenings, contraceptives, and additional services. Impacts of cost-sharing elimination varied depending on clinical service, with a majority of findings showing increases in use. Studies that included socioeconomic status reported that those who were financially vulnerable incurred substantial increases in utilization. Future investigations on additional clinical services are warranted as is research to better elucidate populations who most benefit from cost-sharing elimination.
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Affiliation(s)
- Hope C Norris
- The University of Michigan, Ann Arbor, MI, USA.,New York University, New York, NY, USA
| | | | - Marie-Anais C Benoit
- The University of Michigan, Ann Arbor, MI, USA.,The George Washington University, Washington, DC, USA
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Hong YR, Xie Z, Turner K, Datta S, Bishnoi R, Shah C. Utilization Pattern of Computed Tomographic Colonography in the United States: Analysis of the U.S. National Health Interview Survey. Cancer Prev Res (Phila) 2020; 14:113-122. [DOI: 10.1158/1940-6207.capr-20-0175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/02/2020] [Accepted: 09/08/2020] [Indexed: 11/16/2022]
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Zhao J, Mao Z, Fedewa SA, Nogueira L, Yabroff KR, Jemal A, Han X. The Affordable Care Act and access to care across the cancer control continuum: A review at 10 years. CA Cancer J Clin 2020; 70:165-181. [PMID: 32202312 DOI: 10.3322/caac.21604] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 01/22/2023] Open
Abstract
Lack of health insurance coverage is strongly associated with poor cancer outcomes in the United States. The uninsured are less likely to have access to timely and effective cancer prevention, screening, diagnosis, treatment, survivorship, and end-of-life care than their counterparts with health insurance coverage. On March 23, 2010, the Patient Protection and Affordable Care Act (ACA) was signed into law, representing the largest change to health care delivery in the United States since the introduction of the Medicare and Medicaid programs in 1965. The primary goals of the ACA are to improve health insurance coverage, the quality of care, and patient outcomes, and to maintain or lower costs by catalyzing changes in the health care delivery system. In this review, we describe the main components of the ACA, including health insurance expansions, coverage reforms, and delivery system reforms, provisions within these components, and their relevance to cancer screening and early detection, care, and outcomes. We then highlight selected, well-designed studies examining the effects of the ACA provisions on coverage, access to cancer care, and disparities throughout the cancer control continuum. Finally, we identify research gaps to inform evaluation of current and emerging health policies related to cancer outcomes.
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Affiliation(s)
- Jingxuan Zhao
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ziling Mao
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Stacey A Fedewa
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Leticia Nogueira
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - K Robin Yabroff
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Xuesong Han
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
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Kindratt TB, Dallo FJ, Allicock M, Atem F, Balasubramanian BA. The influence of patient-provider communication on cancer screenings differs among racial and ethnic groups. Prev Med Rep 2020; 18:101086. [PMID: 32309115 PMCID: PMC7155227 DOI: 10.1016/j.pmedr.2020.101086] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 03/09/2020] [Accepted: 03/29/2020] [Indexed: 12/11/2022] Open
Abstract
Our study aimed to estimate how associations between adults' perceptions of specific domains of PPC quality and their likelihood of receiving cancer screenings differed by race and ethnicity. We analyzed 2011-2015 Medical Expenditure Panel Survey (MEPS) data. Samples included 7337 women ages 50-74 (breast), 13,276 women ages 21-65 (cervical), and 9792 adults ages ≥50 years (colorectal). To examine individual domains of PPC quality (independent variables), adults reported how often providers: listened; showed respect; spent enough time; explained things; gave specific instructions; and demonstrated health literate practices (gave clear instructions and asked them to "teach-back" how they will follow instructions). Dependent variables were breast, cervical, and colorectal cancer screenings. Multivariable logistic regression was used to evaluate the odds of receiving cancer screenings using a composite measure of PPC quality and separate domains. Hispanic and non-Hispanic black adults who reported their providers always demonstrated PPC quality had higher odds of receiving colorectal cancer screenings compared to those whose providers did not. Adults' perceptions of whether or not their provider gave them specific instructions increased their odds of receiving breast (Hispanics OR = 1.65, 95% CI = 1.09, 2.51; non-Hispanic blacks OR = 1.54, 95% CI = 1.06, 2.24) and colorectal (non-Hispanic whites OR = 1.37, 95% CI = 1.13, 1.66; Hispanics OR = 1.29, 95% CI = 1.01, 1.66; non-Hispanic blacks OR = 1.92, 95% CI = 1.39, 2.65) cancer screenings. Non-Hispanic Asian women who reported their health care providers demonstrated "teach-back" had higher odds (OR = 2.25; 95% CI = 1.10, 4.62) of receiving cervical cancer screenings. Efforts to improve cancer screenings should focus on training providers to demonstrate health literate practices to improve cancer screenings.
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Affiliation(s)
- Tiffany B Kindratt
- University of Texas at Arlington, Public Health Program, Department of Kinesiology, College of Nursing and Health Innovation, 500 West Nedderman Drive, Arlington, TX 76019-0259, United States
| | - Florence J Dallo
- Oakland University, Department of Public and Environmental Wellness, School of Health Sciences, United States
| | - Marlyn Allicock
- UT Health, The University of Texas Health Science Center at Houston, School of Public Health Dallas, Department of Health Promotion and Behavioral Sciences, United States
| | - Folefac Atem
- UT Health, The University of Texas Health Science Center at Houston, School of Public Health Dallas, Department of Biostatistics and Data Science, United States
| | - Bijal A Balasubramanian
- UT Health, The University of Texas Health Science Center at Houston, School of Public Health Dallas, Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Health Promotion and Prevention Research, UT Southwestern - Harold C. Simmons Comprehensive Cancer Center, United States
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14
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Xu MR, Kelly AMB, Kushi LH, Reed ME, Koh HK, Spiegelman D. Impact of the Affordable Care Act on Colorectal Cancer Outcomes: A Systematic Review. Am J Prev Med 2020; 58:596-603. [PMID: 32008799 PMCID: PMC7175922 DOI: 10.1016/j.amepre.2019.11.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 12/24/2022]
Abstract
CONTEXT The Patient Protection and Affordable Care Act increases healthcare access and includes provisions that directly impact access to and cost of evidence-based colorectal cancer screening. The Affordable Care Act's removal of cost sharing for colorectal cancer screening as well as Medicaid expansion have been hypothesized to increase screening and improve other health outcomes. However, since its passage in 2010, there is little consensus on the Affordable Care Act's impact. EVIDENCE ACQUISITION Data from March 2010 to June 2019 were reviewed and 21 relevant studies were identified; 19 studies examined colorectal cancer screening with most finding increased screening rates. EVIDENCE SYNTHESIS Eleven studies found significant increases, 5 found nonsignificant increases, 3 found nonsignificant decreases, and 1 study found a significant decrease in colorectal cancer screening. Three studies examined the impact on colorectal cancer incidence and stage of diagnosis, where a significant 2.4% increase in early diagnosis was found in one and a nonsignificant increase in incidence in another. However, survival improved after Medicaid expansion. CONCLUSIONS Free preventive colorectal cancer screening and Medicaid expansion because of passage of the Affordable Care Act have been, in general, positively associated with modest improvements in screening rates across the country. Future studies are needed that investigate the longer-term impact of the Affordable Care Act on colorectal cancer morbidity and mortality rates, as screening is only the first step in treatment of cancerous and precancerous lesions, preventing them from progressing. Moreover, more studies examining subpopulations are needed to better assess where gaps in care remain.
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Affiliation(s)
- Michelle R Xu
- Georgetown University School of Medicine, Washington, District of Columbia.
| | - Amanda M B Kelly
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Oakland, Oakland, California
| | - Mary E Reed
- Division of Research, Kaiser Permanente Oakland, Oakland, California
| | - Howard K Koh
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Donna Spiegelman
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
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15
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Abdus S. The role of plan choice in health care utilization of high-deductible plan enrollees. Health Serv Res 2020; 55:119-127. [PMID: 31657012 PMCID: PMC6980946 DOI: 10.1111/1475-6773.13223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To study whether the negative association between enrollment in high-deductible plans and health care utilization is driven by reverse moral hazard or favorable selection, by examining adults with and without a choice of plans. DATA SOURCE 2011-2016 Medical Expenditure Panel Survey Household Component data on nonelderly adults enrolled in employer-sponsored insurance. STUDY DESIGN Four types of plans were examined: high-deductible health plans (HDHPs), consumer-directed health plans (CDHPs), low-deductible health plans (LDHPs), and no-deductible health plans (NDHPs). Multivariate logistic regressions of various measures of health care utilization were conducted to estimate the differences in utilization across plan types among those who had a choice of plans and those who did not. PRINCIPAL FINDINGS Among adults with a choice of plans, HDHP enrollees had lower levels of utilization compared with those of the NDHP enrollees for any ambulatory visit, any specialist visit, and most preventive services. Among adults without any choice of plans, the differences between HDHP enrollees and NDHP enrollees were not statistically significant. CONCLUSIONS The differences between those with and without choice of plans in the relationship between HDHP enrollment and health care utilization might possibly be explained by favorable selection.
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Affiliation(s)
- Salam Abdus
- Division of Research & ModelingCenter for Financing, Access, and Cost TrendsAgency for Healthcare Research & QualityRockvilleMaryland
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16
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Hong YR, Xie Z, Mainous AG, Huo J. Patient-Centered Medical Home and Up-To-Date on Screening for Breast and Colorectal Cancer. Am J Prev Med 2020; 58:107-116. [PMID: 31862097 DOI: 10.1016/j.amepre.2019.08.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Effectiveness of the patient-centered medical home model for promoting cancer screening utilization is uncertain, with prior research showing mixed results. Using national patient-provider pair data, this study examined whether having a patient-centered medical home-certified provider influences receipt of recommended screening for breast and colorectal cancer. METHODS A cross-sectional analysis was performed in 2019 on data from the 2015-2016 Medical Organizational Survey and Medicare Expenditure Panel Survey. Participants included U.S. adults aged 50-75 years who met screening guidelines from the U.S. Preventive Services Task Force. Multivariable regression models estimated the up-to-date rates of breast cancer and colorectal cancer screening between the patient-centered medical home and non-patient-centered medical home groups. RESULTS The study sample comprised 4,052 patient-provider pairs, representing a weighted 40.1 million screening-eligible individuals cared for by 2,314 practices. Of those, 1,909 (48.2%) were cared for by patient-centered medical home-certified providers. Unadjusted up-to-date rates were similar between patient-centered medical homes and non-patient-centered medical homes (breast cancer screening, 85.4% vs 83.4%; colorectal cancer screening, 73.3% vs 73.3%). Adjusted analysis indicated no significant differences in rates of breast cancer (p=0.228) or colorectal cancer screening (p=0.878). In subgroup analyses, however, having a patient-centered medical home-certified provider was associated with higher screening rates among individuals aged 50-64 years and those with a private plan for breast cancer and among other racial/ethnic minorities for colorectal cancer. CONCLUSIONS Obtaining care from a patient-centered medical home-certified provider is not associated with increased breast cancer or colorectal cancer screening uptake. Findings of this study suggest that tailoring cancer screening strategies to patient mix may be needed to improve cancer screening utilization in patient-centered medical homes.
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Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida.
| | - Zhigang Xie
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida
| | - Arch G Mainous
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida; Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Jinhai Huo
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida
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17
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Gakh M, Cris C, Cheong P, Coughenour C. A State of Uncertainty: An Analysis of Recent State Legislative Proposals to Regulate Preventive Services in the United States. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2019; 56:46958019841514. [PMID: 31018737 PMCID: PMC6484240 DOI: 10.1177/0046958019841514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This policy brief examines preventive services state legislation trends in the United States during uncertainty regarding the Affordable Care Act (ACA), which requires certain coverage of 4 evidence-based preventive services categories without additional patient costs under §2713. We used a legal mapping approach to search for and analyze state legislation related to preventive services proposed or enacted over a 25-month period of ACA uncertainty. We screened 1231 bills and coded the 76 screened-in bills. Next, we determined their characteristics and examined trends. Bills originated in 28 states, and 69.7% were not enacted. Only 3.9% contained requirements contingent on ACA modifications. About 56.6% referenced services covered by §2713, but usually not entire §2713 categories. Bills also mentioned preventive services in general (53.9%) and services outside §2713’s scope (21.1%). About 55.3% applied to private insurance, and 75.0% only to one patient group. Bills generally promoted access, and 51.3% specifically prohibited cost-sharing. But 26.3% of the bills limited access to preventive services. State-level legislation targets preventive services, usually expanding, but sometimes limiting, access. Most bills single out specific services without fully incorporating evidence-based recommendations. State legislation may therefore promote access to preventive services but can favor certain services, deviate from experts’ recommendations, and increase nationwide variability. State legislation can function as an important lever for access to preventive services across patient groups. This may be especially important during uncertainty about federal policy. However, the design of state-level proposals is critical for maximizing access to preventive services.
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Affiliation(s)
| | - Cody Cris
- 1 University of Nevada, Las Vegas, USA
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18
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Tak CR, Kim J, Gunning K, Sherwin CM, Nickman NA, Biskupiak JE. Cost-Sharing Requirements for the Herpes Zoster Vaccine in Adults Aged 60. J Pharm Technol 2019; 35:258-269. [PMID: 34752508 PMCID: PMC6726872 DOI: 10.1177/8755122519860074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Rates of zoster vaccination in US adults aged 60+ were approximately 30.6% in 2015. Out-of-pocket cost-sharing has been identified as a major barrier to vaccination for patients. To date, herpes zoster vaccine cost-sharing requirements for adults aged 60 to 64 has not been described. Objective: Compare the cost-sharing requirements for zoster vaccination in adults aged 60 to 64 and adults aged 65+. Methods: A retrospective cohort design examined pharmacy claims for zoster vaccination from the Utah All Payer Claims Database for adults aged 60+. Descriptive statistics and a 2-part cost model compared cost-sharing requirements for adults aged 60 to 64 and adults 65+. Results: Of the 30 293 zoster vaccine claims, 13 398 (45.8%) had no cost-sharing, 1716 (5.9%) had low cost-sharing (defined as $1 to less than $30), and 14 133 (48.3%) had high cost-sharing (defined as $30 or more). In the cost models, adults aged 65+ had higher odds of any cost-sharing (odds ratio = 39.86) and 29% higher cost-sharing as compared with adults aged 60 to 64. Conclusions: Adults aged 60 to 64 encounter lower cost-sharing requirements than adults aged 65+. Providers should be cognizant of this dynamic and encourage zoster vaccination prior to the age of 65.
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Affiliation(s)
- Casey R Tak
- University of North Carolina at Chapel Hill, NC, USA.,UNC Health Sciences at MAHEC, Asheville, NC, USA
| | | | | | - Catherine M Sherwin
- Wright State University, Dayton, OH, USA.,Dayton Children's Hospital, Dayton, OH, USA
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19
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Park S, Chen J, Ma GX, Ortega AN. Utilization of essential preventive health services among Asians after the implementation of the preventive services provisions of the Affordable Care Act. Prev Med Rep 2019; 16:101008. [PMID: 31890468 PMCID: PMC6931224 DOI: 10.1016/j.pmedr.2019.101008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/11/2019] [Accepted: 10/20/2019] [Indexed: 11/22/2022] Open
Abstract
Utilization of cost-effective essential preventive health services increased after the implementation of the Affordable Care Act's (ACA) provision that non-grandfathered private insurers provide cost-effective preventive services without cost sharing in 2010. Little is known, however, whether this change is also observed among Asians in the US. We examined patterns of preventive services utilization among Asian subgroups relative to non-Latino whites (whites) after the implementation of the ACA's preventive services provisions. Using 2013-2016 Medical Expenditure Panel Survey data, we examined utilization trends in preventive services among Asian Indians, Chinese, Filipinos, and other Asians relative to whites. We also ran logistic regression models to estimate the likelihood of having received each of the seven essential preventive services (routine checkups, flu vaccinations, cholesterol screenings, blood pressure checkups, Papanicolaou "pap" tests, mammograms, and colorectal cancer screenings). Compared to whites, Asians had higher rates of utilization of routine checkups, cholesterol screenings, and flu vaccinations, but they had lower utilization rates of blood pressure checkups, pap tests, and mammograms. The patterns of preventive services utilization differed across the Asian subgroups. All Asian subgroups, except for Filipinos, were less likely to have pap tests or mammograms than whites. Moreover, we observed a decreasing trend in having pap tests, mammograms, or colorectal cancer screenings among all Asian subgroups between 2013 and 2016. Our findings suggest that there are low cancer screening rates across Asian subgroups. This indicates the need for programs tailored to specific Asian subgroups to improve cancer screening.
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Affiliation(s)
- Sungchul Park
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, 3125 Market Street, Nesbitt Hall 3rd Floor, Philadelphia, PA 19104, United States
| | - Jie Chen
- Department of Health Policy and Management, School of Public Health, University of Maryland, 4200 Valley Drive, Suite 2242, College Park, MD 20742, United States
| | - Grace X. Ma
- Department of Clinical Sciences and Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA 19140, United States
| | - Alexander N. Ortega
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, 3125 Market Street, Nesbitt Hall 3rd Floor, Philadelphia, PA 19104, United States
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20
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Hong YR, Cardel M, Suk R, Vaughn IA, Deshmukh AA, Fisher CL, Pavela G, Sonawane K. Teach-Back Experience and Hospitalization Risk Among Patients with Ambulatory Care Sensitive Conditions: a Matched Cohort Study. J Gen Intern Med 2019; 34:2176-2184. [PMID: 31385206 PMCID: PMC6816654 DOI: 10.1007/s11606-019-05135-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/29/2019] [Accepted: 05/20/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND The teach-back method, also known as the "show-me" method, has been endorsed by many medical and health care societies. However, limited investigation has been conducted regarding its association with patient outcomes. OBJECTIVES To examine the association between patient teach-back experience and the risk of hospitalizations and length of hospital stay among patients with ambulatory care sensitive conditions (ACSCs). DESIGN A matched cohort study. SETTING Data from the 2011-2015 Longitudinal Medical Expenditure Panel Survey (panels 16-19). PARTICIPANTS Three thousand nine hundred ninety-four US adults aged ≥ 18 years with any of 5 ACSCs (hypertension, type 2 diabetes, heart disease, asthma, and chronic obstructive pulmonary disease [COPD]). MEASUREMENTS Hospital admissions (all-cause or ACSC-related) and the length of stay of the first admission were examined by teach-back during interaction with a health provider. RESULTS Patients with teach-back experience were less likely to experience hospitalization for an ACSC-related condition (relative risk, 0.85; 95% CI, 0.71 to 0.99) and had a lower risk for a condition-related readmission (hazard ratio, 0.77; 95% CI, 0.60 to 0.99), compared with those without teach-back experience. The median length of hospital stay did not differ between patients with teach-back experience and those without teach-back experience (median 3 days [IQR 1 to 8 days] and median 3 days [IQR 0 to 8 days], respectively; P = 0.84). Subgroup analysis showed that the association of reported teach-back experience on the outcomes was relatively stable among those with hypertension, diabetes, and heart disease, but was not among those with asthma or COPD. LIMITATION Teach-back exposure relied on patient self-reported information. CONCLUSIONS Our findings suggest that patient teach-back method is associated with reduced risk of hospitalization for those with ACSCs, especially among patients with cardiovascular diseases and type 2 diabetes. Encouraging providers to utilize the teach-back method at every visit has the potential to further reduce hospitalizations for individuals with ACSCs.
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Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research, Management and Policy in the College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
| | - Michelle Cardel
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ryan Suk
- Department of Management, Policy and Community Health, The University of Texas Health Science Center, Houston, TX, USA
| | - Ivana A Vaughn
- Center for Evaluation and Applied Research, The New York Academy of Medicine, New York, NY, USA
| | - Ashish A Deshmukh
- Department of Management, Policy and Community Health, The University of Texas Health Science Center, Houston, TX, USA
| | - Carla L Fisher
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL, USA.,UF Health Cancer Center, Center for Arts in Medicine, STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
| | - Gregory Pavela
- Department of Health Behavior, School of Public Health University of Alabama, Birmingham, AL, USA
| | - Kalyani Sonawane
- Department of Management, Policy and Community Health, The University of Texas Health Science Center, Houston, TX, USA
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21
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Hong YR, Smith GL, Xie Z, Mainous AG, Huo J. Financial burden of cancer care under the Affordable Care Act: Analysis of MEPS-Experiences with Cancer Survivorship 2011 and 2016. J Cancer Surviv 2019; 13:523-536. [PMID: 31183677 PMCID: PMC6679733 DOI: 10.1007/s11764-019-00772-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/25/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine whether the implementation of Affordable Care Act (ACA) reduced the financial burden associated with cancer care among non-elderly cancer survivors. METHODS Using data from the MEPS-Experiences with Cancer Survivorship Survey, we examined whether there was a difference in financial burden associated with cancer care between 2011 (pre-ACA) and 2016 (post-ACA). Two aspects of financial burden were considered: (1) self-reported financial burden, whether having financial difficulties associated with cancer care and (2) high-burden spending, whether total out-of-pocket (OOP) spending incurred in excess of 10% or 20% of family income. Generalized linear regression models were estimated to adjust the OOP expenditures (reported in 2016 US dollar). RESULTS Our sample included adults aged 18-64 with a confirmed diagnosis of any cancer in 2011 (n = 655) and in 2016 (n = 490). There was no apparent difference in the prevalence of cancer survivors reporting any financial hardship or being with high-burden spending between 2011 and 2016. The mean OOP decreased by $268 (95% CI, - 384 to - 152) after the ACA. However, we found that the mean premium payments increased by $421 (95% CI, 149 to 692) in the same period. CONCLUSIONS The ACA was associated with reduced OOP for health services but increased premium contributions, resulting in no significant impact on perceived financial burden among non-elderly cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS The financial hardship of cancer survivorship points to the need for the development of provisions that help cancer patients reduce both perceived and materialized burden of cancer care under ongoing health reform.
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Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA.
| | - Grace L Smith
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zhigang Xie
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Arch G Mainous
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, USA
| | - Jinhai Huo
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
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22
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Huguet N, Angier H, Rdesinski R, Hoopes M, Marino M, Holderness H, DeVoe JE. Cervical and colorectal cancer screening prevalence before and after Affordable Care Act Medicaid expansion. Prev Med 2019; 124:91-97. [PMID: 31077723 PMCID: PMC6578572 DOI: 10.1016/j.ypmed.2019.05.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 05/03/2019] [Accepted: 05/07/2019] [Indexed: 11/22/2022]
Abstract
Community health centers (CHCs), which serve socioeconomically disadvantaged patients, experienced an increase in insured visits after the 2014 Affordable Care Act (ACA) coverage options began. Yet, little is known about how cancer screening rates changed post-ACA. Therefore, this study assessed changes in the prevalence of cervical and colorectal cancer screening from pre- to post-ACA in expansion and non-expansion states among patients seen in CHCs. Electronic health record data on 624,601 non-pregnant patients aged 21-64 eligible for cervical or colorectal cancer screening between 1/1/2012 and 12/31/2015 from 203 CHCs were analyzed. We assessed changes in prevalence and screening likelihood among patients, by insurance type and race/ethnicity and compared Medicaid expansion and non-expansion states using difference-in-difference methodology. Female patients had 19% increased odds of receiving cervical cancer screening post- relative to pre-ACA in expansion states [adjusted odds ratio (aOR) = 1.19, 95% confidence interval (CI) = 1.09-1.31] and 23% increased odds in non-expansion states (aOR = 1.23, 95% CI = 1.05-1.46): the greatest increase was among uninsured patients in expansion states (aOR = 1.36, 95% CI = 1.16-1.59) and privately-insured patients in non-expansion states (aOR = 1.43, 95% CI = 1.11-1.84). Colorectal cancer screening prevalence increased from 11% to 18% pre- to post-ACA in expansion states and from 13% to 21% in non-expansion states. For most outcomes, the observed changes were not significantly different between expansion and non-expansion states. Despite increased prevalences of cervical and colorectal cancer screening in both expansion and non-expansion states across all race/ethnicity groups, rates remained suboptimal for this population of socioeconomically disadvantaged patients.
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Affiliation(s)
- Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, United States
| | - Heather Angier
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, United States
| | - Rebecca Rdesinski
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, United States
| | - Megan Hoopes
- OCHIN Inc., 1881 SW Naito Pkwy, Portland, OR, 97201, United States
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, United States; Division of Biostatistics, School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States
| | - Heather Holderness
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, United States.
| | - Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, United States
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23
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Patient-centered care factors and access to care: a path analysis using the Andersen behavior model. Public Health 2019; 171:41-49. [DOI: 10.1016/j.puhe.2019.03.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/19/2019] [Accepted: 03/29/2019] [Indexed: 11/21/2022]
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24
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Alharbi A, Khan MM, Horner R, Brandt H, Chapman C. Impact of removing cost sharing under the affordable care act (ACA) on mammography and pap test use. BMC Public Health 2019; 19:370. [PMID: 30943933 PMCID: PMC6446257 DOI: 10.1186/s12889-019-6665-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Affordable Care Act (ACA) required private insurers and Medicare to cover recommended preventive services without any cost sharing to improve utilization of these services. This study is an attempt to identify the impact of removing cost sharing on mammography and pap test utilization rates. METHODS Counterfactual analysis was used to predict what would have been the screening rates in post-ACA if ACA was not there. This was done by estimating a model that examines determinants of dependent variable for the pre-ACA year (pre-ACA year is 2009). The estimated model was then used to predict the dependent variable for the post-ACA year using individual characteristics and other relevant variables unlikely to be affected by ACA (post-ACA year is 2016). Effect of ACA is defined as the difference between the values of dependent variables in post-ACA and the predicted values of dependent variables in the post-ACA year using counterfactual. RESULTS The counterfactual analysis show that the utilization of mammogram and pap test did not improve following ACA. CONCLUSION Removal of cost-sharing under the ACA did not improve mammography or pap test rates. Therefore, financial barrier may not be an important factor in affecting utilization of the screening tests and policy makers should focus on other non-financial barriers in order to improve coverage of the tests.
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Affiliation(s)
- Abeer Alharbi
- Health Services Policy and Management department, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - M. Mahmud Khan
- Health Services Policy and Management department, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Ronnie Horner
- Health Services Policy and Management department, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Heather Brandt
- Health Promotion, Education, and Behavior department, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Cole Chapman
- Health Services Policy and Management department, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
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Impact of The Affordable Care Act's Elimination of Cost-Sharing on the Guideline-Concordant Utilization of Cancer Preventive Screenings in the United States Using Medical Expenditure Panel Survey. Healthcare (Basel) 2019; 7:healthcare7010036. [PMID: 30832276 PMCID: PMC6473889 DOI: 10.3390/healthcare7010036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/30/2019] [Accepted: 02/26/2019] [Indexed: 12/21/2022] Open
Abstract
Currently available evidence regarding the association of the Affordable Care Act’s (ACA) elimination of cost-sharing and the utilization of cancer screenings is mixed. We determined whether the ACA’s zero cost-sharing policy affected the guideline-concordant utilization of cancer screenings, comparing adults (≥21 years) from 2009 with 2011–2014 data from the Medical Expenditure Panel Survey. Study participants were categorized as: 21–64 years with any private insurance, ≥65 years with Medicare only, and 21–64 years uninsured, with a separate sample for each type of screening test. Adjusted weighted prevalence and prevalence ratios (PR (95%CI)) were estimated. In 2014 (vs. 2009), privately-insured women reported 2% (0.98 (0.97–0.99)) and 4% (0.96 (0.93–0.99)) reduction in use of Pap tests and mammography, respectively. Privately-insured non-Hispanic Asian women had 16% (0.84 (0.74–0.97)) reduction in mammography in 2014 (vs. 2009). In 2011 (vs. 2009), privately-insured and Medicare-only men reported 9% (1.09 (1.03–1.16)) and 13% (1.13 (1.02–1.25)) increases in colorectal cancer (CRC) screenings, respectively. Privately-insured women reported a 6–7% rise in 2013–2014 (vs. 2009), and Hispanic Medicare beneficiaries also reported 40–44%, a significant rise in 2011–2014 (vs. 2009), in the utilization of CRC screenings. While the guideline-concordant utilization of Pap tests and mammography declined in the post-ACA period, the elimination of cost-sharing appeared to have positively affected CRC screenings of privately-insured males, females, and Hispanic Medicare-only beneficiaries. Greater awareness about the zero cost-sharing policy may help in increasing the uptake of cancer screenings.
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Impact of Provider Participation in ACO Programs on Preventive Care Services, Patient Experiences, and Health Care Expenditures in US Adults Aged 18–64. Med Care 2018; 56:711-718. [DOI: 10.1097/mlr.0000000000000935] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Hong YR, Sonawane KB, Holcomb DR, Deshmukh AA. Effect of multimodal information delivery for diabetes care on colorectal cancer screening uptake among individuals with type 2 diabetes. Prev Med Rep 2018; 11:89-92. [PMID: 29984144 PMCID: PMC6030234 DOI: 10.1016/j.pmedr.2018.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 04/24/2018] [Accepted: 05/05/2018] [Indexed: 11/16/2022] Open
Abstract
Despite the significant increase in the risk of colorectal cancer (CRC), one-third of individuals with diabetes who met screening recommendations, reported not being up-to-date on CRC screening in the United States. We determined the means through which individuals with type 2 diabetes (T2DM) learned about diabetes care; we further examined their associations with CRC screening uptake. This was a retrospective study of US adults aged 50-75 years diagnosed with T2DM (sample n = 5595, representing 14,724,933 Americans). Data from the 2011-2014 Medical Expenditure Panel Survey were analyzed to compare CRC screening uptake in four learning groups for diabetes care: (1) did not learn, (2) learning from health providers only, (3) learning from other sources (including online sources and group class), and (4) learning from health providers and other sources together (combined learning group). Overall, 70.4% individuals with T2DM were up-to-date with CRC screening during 2011-2014. In multivariate logistic regression analysis, the combined learning group had 1.32 (95% confidence interval, 1.01-1.74) times higher odds of being up-to-date on CRC screening than those who did not learn about diabetes care. The odds of being up-to-date on CRC screening were not significant for other learning groups. Our findings suggest that combined ways of health information delivery for diabetes care is associated with increased odds of being up-to-date on CRC screening among individuals with T2DM. Multimodal health information delivery has the potential to result in unintended, positive consequences in preventive care services use.
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Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, United States
- Corresponding author at: Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, 1225 Center Drive, HPNP 3118, University of Florida, Gainesville, FL 32611, United States.
| | - Kalyani B. Sonawane
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, United States
| | - Derek R. Holcomb
- Department of Public Health, Eastern Kentucky University, Richmond, KY, United States
| | - Ashish A. Deshmukh
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, United States
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Hong YR, Tauscher J, Cardel M. Distrust in health care and cultural factors are associated with uptake of colorectal cancer screening in Hispanic and Asian Americans. Cancer 2017; 124:335-345. [PMID: 28976535 DOI: 10.1002/cncr.31052] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/01/2017] [Accepted: 09/05/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND There are racial/ethnic disparities in colorectal cancer (CRC) screening, including lower uptake rates among Hispanic Americans (HAs) and Asian Americans (AAs) relative to non-Hispanic white Americans. The objective of this study was to explore pathways associated with the use of health services and to characterize multifaceted associations with the uptake of CRC screening among HAs and AAs. METHODS Data were obtained from the Medical Expenditure Panel Survey (2012-2013). Participants included HA (n = 3731) and AA (n = 1345) respondents ages 50 to 75 years who met CRC screening recommendations. A modified Andersen behavioral model was used to examine pathways that lead to CRC screening uptake, including predisposing characteristics (education, economic, and cultural factors), health insurance, health needs (perceived health status and several comorbidities), and health provider contextual factors (access to care, perceived quality of health services, and distrust in health care). Structural equation modeling was used to examine the models for HAs and AAs. RESULTS In the HA model, cultural factors (standardized regression coefficient [β] = -0.04; P = .013) and distrust in health care (β = -0.05; P = .007) directly and negatively affected CRC screening. Similarly, cultural factors (β = -0.11; P = .002) negatively affected CRC screening in the AA model, but distrust in health care was not significant (P = .103). In both models, perceived quality of health services was positively associated with CRC screening uptake and mediated the negative association between cultural factors and CRC screening. Access to care was not associated with CRC screening. CONCLUSIONS Correlations between CRC screening and associated factors differ among HAs and AAs, suggesting a need for multilevel interventions tailored to race/ethnicity. The current findings suggest that facilitating access to care without improving perceived quality of health services may be ineffective for increasing the uptake of CRC screening among HAs and AAs. Cancer 2018;124:335-45. © 2017 American Cancer Society.
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Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Justin Tauscher
- Counseling and Counselor Education, College of Education, University of Florida, Gainesville, Florida
| | - Michelle Cardel
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida
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