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Nilchian P, Purkayastha S, Thomas G, Curtis KL, Roszkowska N, Benitez EK, Merlinsky T, Farid M, Nicol CEW, Batavia AS, Charney P. Digital Reimbursement Systems in a Student-Run Clinic. J Community Health 2024:10.1007/s10900-024-01391-0. [PMID: 39187724 DOI: 10.1007/s10900-024-01391-0] [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: 08/10/2024] [Indexed: 08/28/2024]
Abstract
The increasing reliance on digital tools for standard healthcare practices in uninsured populations is poorly understood. This study aims to assess the impacts of a newly implemented digital reimbursement system at a student-run primary care clinic associated with an academic medical institution serving uninsured New York City residents. Pharmacy records of 94 unique patients receiving a total of 2770 reimbursements between October 17th, 2016, and May 18th, 2023, were analyzed. Patients were divided into two groups (in-person vs. digital) based on their reimbursement preferences type. Demographic analyses were performed in addition to assessing reimbursement volumes, number of refunds, and duration until receipt of payment for each group. The clinic's total monthly reimbursement volume, number of prescriptions, and number of patients for the period before introduction of digital refunds was compared to the period after. The mean age (in-person = 52.7 ± 14.7 years, digital = 54.9 ± 12.9 years) was not statistically different between the groups. Patients in the digital group requested on average more refunds (digital = 47 refunds, in-person = 14 refunds), received higher total reimbursement amount (digital = $1131.24, in-person = $289.36), and they were reimbursed faster (digital = 56 days, in-person = 62 days). Since the introduction of the digital reimbursement option, our three-month reimbursement volume more than doubled from $481 to $1298. The average number of monthly reimbursements increased from 27 to 45 refunds, and the number of monthly patients increased from 6 to 9 patients. In summary, digital reimbursement options can facilitate medication reimbursement among uninsured patients. These results suggest that digital reimbursement systems result in higher utilization, faster refunds, and larger total reimbursements amount for uninsured and underserved patients.
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Affiliation(s)
- Parsa Nilchian
- Weill Cornell Community Clinic, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10021, USA.
| | - Subhanik Purkayastha
- Weill Cornell Community Clinic, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10021, USA
| | - Gianni Thomas
- Weill Cornell Community Clinic, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10021, USA
| | - Kaya L Curtis
- Weill Cornell Community Clinic, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10021, USA
| | - Natalia Roszkowska
- Weill Cornell Community Clinic, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10021, USA
| | - Elizabeth K Benitez
- Weill Cornell Community Clinic, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10021, USA
| | - Tiffany Merlinsky
- Weill Cornell Community Clinic, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10021, USA
| | - Michael Farid
- Weill Cornell Community Clinic, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10021, USA
| | - Cecilia E W Nicol
- Weill Cornell Community Clinic, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10021, USA
- Department of Internal Medicine, NewYork Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Ashita S Batavia
- Weill Cornell Community Clinic, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10021, USA
- Department of Internal Medicine, NewYork Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Pamela Charney
- Weill Cornell Community Clinic, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10021, USA
- Department of Internal Medicine, NewYork Presbyterian/Weill Cornell Medicine, New York, NY, USA
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Shang D, Williams C, Culiqi H. Telehealth Uptake Among Hispanic People During COVID-19: Retrospective Observational Study. JMIR Med Inform 2024; 12:e57717. [PMID: 39051154 PMCID: PMC11289584 DOI: 10.2196/57717] [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: 02/24/2024] [Revised: 05/11/2024] [Accepted: 05/12/2024] [Indexed: 07/27/2024] Open
Abstract
Background The Hispanic community represents a sizeable community that experiences inequities in the US health care system. As the system has moved toward digital health platforms, evaluating the potential impact on Hispanic communities is critical. Objective The study aimed to investigate demographic, socioeconomic, and behavioral factors contributing to low telehealth use in Hispanic communities. Methods We used a retrospective observation study design to examine the study objectives. The COVID-19 Research Database Consortium provided the Analytics IQ PeopleCore consumer data and Office Alley claims data. The study period was from March 2020 to April 2021. Multiple logistic regression was used to determine the odds of using telehealth services. Results We examined 3,478,287 unique Hispanic patients, 16.6% (577,396) of whom used telehealth. Results suggested that patients aged between 18 and 44 years were more likely to use telehealth (odds ratio [OR] 1.07, 95% CI 1.05-1.1; P<.001) than patients aged older than 65 years. Across all age groups, patients with high incomes were at least 20% more likely to use telehealth than patients with lower incomes (P<.001); patients who had a primary care physician (P=.01), exhibited high medical usage (P<.001), or were interested in exercise (P=.03) were more likely to use telehealth; patients who had unhealthy behaviors such as smoking and alcohol consumption were less likely to use telehealth (P<.001). Male patients were less likely than female patients to use telehealth among patients aged 65 years and older (OR 0.94, 95% CI 0.93-0.95; P<.001), while male patients aged between 18 and 44 years were more likely to use telehealth (OR 1.05, 95% CI 1.03-1.07; P<.001). Among patients younger than 65 years, full-time employment was positively associated with telehealth use (P<.001). Patients aged between 18 and 44 years with high school or less education were 2% less likely to use telehealth (OR 0.98, 95% CI 0.97-0.99; P=.005). Results also revealed a positive association with using WebMD (WebMD LLC) among patients aged older than 44 years (P<.001), while there was a negative association with electronic prescriptions among those who were aged between 18 and 44 years (P=.009) and aged between 45 and 64 years (P=.004). Conclusions This study demonstrates that telehealth use among Hispanic communities is dependent upon factors such as age, gender, education, socioeconomic status, current health care engagement, and health behaviors. To address these challenges, we advocate for interdisciplinary approaches that involve medical professionals, insurance providers, and community-based services actively engaging with Hispanic communities and promoting telehealth use. We propose the following recommendations: enhance access to health insurance, improve access to primary care providers, and allocate fiscal and educational resources to support telehealth use. As telehealth increasingly shapes health care delivery, it is vital for professionals to facilitate the use of all available avenues for accessing care.
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Affiliation(s)
- Di Shang
- University of North Florida, Jacksonville, FL, United States
| | | | - Hera Culiqi
- University of North Florida, Jacksonville, FL, United States
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Jivalagian P, Gettel CJ, Smith CM, Robinson L, Brinker M, Shah D, Kumar A, Faustino IV, Nath B, Chang-Sing E, Taylor RA, Kennedy M, Hwang U, Wong AH. Racial, Ethnic, and Age-Related Disparities in Sedation and Restraint Use for Older Adults in the Emergency Department. Am J Geriatr Psychiatry 2024:S1064-7481(24)00398-1. [PMID: 39054237 DOI: 10.1016/j.jagp.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVES Older adults may present to the emergency department (ED) with agitation, a symptom often resulting in chemical sedation and physical restraint use which carry significant risks and side effects for the geriatric population. To date, limited literature describes the patterns of differential restraint use in this population. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS This retrospective cross-sectional study used electronic health records data from ED visits by older adults (age ≥65 years) ranging 2015-2022 across nine hospital sites in a regional hospital network. Logistic regression models were estimated to determine the association between patient-level characteristics and the primary outcomes of chemical sedation and physical restraint. RESULTS Among 872,587 ED visits during the study period, 11,875 (1.4%) and 32,658 (3.7%) encounters involved the use of chemical sedation and physical restraints respectively. The populations aged 75-84, 85-94, 95+ years had increasingly higher odds of chemical sedation [adjusted odds ratios (AORs) 1.35 (95% CI 1.29-1.42); 1.82 (1.73-1.91); 2.35 (2.15-2.57) respectively] as well as physical restraint compared to the 65-74 group [AOR 1.31 (1.27-1.34); 1.55 (1.50-1.60); 1.69 (1.59-1.79)]. Compared to the White Non-Hispanic group, the Black Non-Hispanic and Hispanic/Latinx groups had significantly higher odds of chemical sedation [AOR 1.26 (1.18-1.35); AOR 1.22 (1.15-1.29)] and physical restraint [AOR 1.12 (95% CI 1.07-1.16); 1.22 (1.18-1.26)]. CONCLUSION Approximately one in 20 ED visits among older adults resulted in chemical sedation or physical restraint use. Minoritized group status was associated with increasing use of chemical sedation and physical restraint, particularly among the oldest old. These results may indicate the need for further research in agitation management for historically marginalized populations in older adults.
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Affiliation(s)
- Patelle Jivalagian
- Department of Emergency Medicine (PJ, CJG, LR, DS, AK, IVF, BN, ECS, RAT, AHW), Yale School of Medicine, New Haven, CT
| | - Cameron J Gettel
- Department of Emergency Medicine (PJ, CJG, LR, DS, AK, IVF, BN, ECS, RAT, AHW), Yale School of Medicine, New Haven, CT
| | - Colin M Smith
- Hubert-Yeargan Center for Global Health (CMS), Duke University, Durham, NC
| | - Leah Robinson
- Department of Emergency Medicine (PJ, CJG, LR, DS, AK, IVF, BN, ECS, RAT, AHW), Yale School of Medicine, New Haven, CT
| | - Morgan Brinker
- Department of Emergency Medicine, Yale School of Medicine (MB), New Haven, CT
| | - Dhruvil Shah
- Department of Emergency Medicine (PJ, CJG, LR, DS, AK, IVF, BN, ECS, RAT, AHW), Yale School of Medicine, New Haven, CT
| | - Anusha Kumar
- Department of Emergency Medicine (PJ, CJG, LR, DS, AK, IVF, BN, ECS, RAT, AHW), Yale School of Medicine, New Haven, CT
| | - Isaac V Faustino
- Department of Emergency Medicine (PJ, CJG, LR, DS, AK, IVF, BN, ECS, RAT, AHW), Yale School of Medicine, New Haven, CT
| | - Bidisha Nath
- Department of Emergency Medicine (PJ, CJG, LR, DS, AK, IVF, BN, ECS, RAT, AHW), Yale School of Medicine, New Haven, CT
| | - Erika Chang-Sing
- Department of Emergency Medicine (PJ, CJG, LR, DS, AK, IVF, BN, ECS, RAT, AHW), Yale School of Medicine, New Haven, CT
| | - R Andrew Taylor
- Department of Emergency Medicine (PJ, CJG, LR, DS, AK, IVF, BN, ECS, RAT, AHW), Yale School of Medicine, New Haven, CT; Department of Biomedical Informatics and Data Science (RAT), Yale School of Medicine, New Haven, CT
| | - Maura Kennedy
- Department of Emergency Medicine (MK), Massachusetts General Hospital, Boston, MA; Department of Emergency Medicine (MK), Harvard Medical School, Boston, MA
| | - Ula Hwang
- Department of Emergency Medicine (UH), New York University Grossman School of Medicine, New York, NY; Geriatric Research Education and Clinical Center (UH), James J. Peters VAMC, Bronx, NY
| | - Ambrose H Wong
- Department of Emergency Medicine (PJ, CJG, LR, DS, AK, IVF, BN, ECS, RAT, AHW), Yale School of Medicine, New Haven, CT.
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Crimmel S, Hu L, D'Souza RS, Wang EJ. Treatment Disparities in Hispanic Patients with Chronic Pain: An Evidence-Based Narrative Review. Curr Pain Headache Rep 2024; 28:271-278. [PMID: 38358442 DOI: 10.1007/s11916-024-01220-y] [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: 01/30/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE OF REVIEW The purpose of this narrative review is to summarize healthcare disparities experienced by Hispanic and Latino/Latinx patients with chronic pain, evaluate the existing literature exploring the specific therapeutic inequities affecting this patient population, and identify gaps in the literature requiring future study. RECENT FINDINGS Hispanic and Latino/Latinx patients experience disparities in chronic pain management. They are less likely to be prescribed pharmacologic therapies, including non-steroidal anti-inflammatory drugs and opioids. Hispanic and Latino/Latinx patients are also less likely to receive spinal cord stimulators and may be charged higher costs for them. There are no published studies specifically assessing Hispanic and Latino/Latinx patients' utilization and outcomes from other common interventional pain procedures (e.g., epidural steroid injections, radiofrequency ablation). Limited data suggest non-pharmacologic treatments, such as cognitive behavioral therapy and complementary/integrative health modalities, might have more benefit for this population, potentially because of greater utilization. Hispanic and Latino/Latinx patients experience disparities in chronic pain management. There is a paucity of data available pertaining specifically to pain-related outcomes and the utilization of pain treatment modalities, especially in regard to interventional procedures. Additional research is urgently needed in order to understand the full extent of these disparities and develop solutions to provide more equitable care.
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Affiliation(s)
- Stephanie Crimmel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Lizbeth Hu
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Eric J Wang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Yuan X, Zhang X, He J, Xing W. Interventions for financial toxicity among cancer survivors: A scoping review. Crit Rev Oncol Hematol 2023; 192:104140. [PMID: 37739147 DOI: 10.1016/j.critrevonc.2023.104140] [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: 02/03/2023] [Revised: 09/09/2023] [Accepted: 09/16/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION Financial toxicity impairs cancer survivors' material condition, psychological wellbeing and quality of life. This scoping review aimed to identify interventions for reducing cancer-related financial toxicity (FT), and to summarize their main findings. METHODS A systematic search was performed in PubMed, Web of Science, EMBASE, CINAHL, Clinical Trials, China National Knowledge Internet, Wanfang and SinoMed from January 2010 to September 2022 following the PRISMA-ScR checklist. RESULTS From 2842 identified articles, a total of 15 were included in this review. Existing interventions can be classified into four types: financial navigation, financial counseling, insurance education and others. Previous interventions preliminarily affirmed the feasibility, satisfaction, and improvement in financial worries and knowledge. However, the effectiveness on FT was controversial. CONCLUSIONS Previous interventions affirmed the feasibility and primary effect of these interventions. Studies with more rigorous design are needed to evaluate the effectiveness and generalizability of interventions on FT across diverse healthcare systems.
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Affiliation(s)
- Xiaoyi Yuan
- School of nursing, Fudan University, Shanghai, China
| | - Xuehui Zhang
- School of nursing, Fudan University, Shanghai, China
| | - Jing He
- School of nursing, Fudan University, Shanghai, China
| | - Weijie Xing
- School of nursing, Fudan University and core research member of Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China.
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A multimodal strategy to improve race/ethnic group equity in administration of neutralizing monoclonal antibody treatment for COVID-19 outpatients. J Clin Transl Sci 2023; 7:e37. [PMID: 36845303 PMCID: PMC9947608 DOI: 10.1017/cts.2022.526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/17/2022] [Accepted: 12/13/2022] [Indexed: 02/12/2023] Open
Abstract
Introduction Racial and ethnic minority groups have higher rates of SARS-CoV-2 infection, severe illness, and death; however, they receive monoclonal antibody (mAb) treatment at lower rates than non-Hispanic White patients. We report data from a systematic approach to improve equitable provision of COVID-19 neutralizing monoclonal antibody treatment. Methods Treatment was administered at a community health urgent care clinic affiliated with a safety-net urban hospital. The approach included a stable treatment supply, a same-day test and treat model, a referral process, patient outreach, and financial support. We analyzed the race/ethnicity data descriptively and compared proportions using a chi-square test. Results Over 17 months, 2524 patients received treatment. Compared to the demographics of county COVID-19-positive cases, a greater proportion of patients who received mAb treatment were Hispanic (44.7% treatment vs. 36.5% positive cases, p < 0.001), a lower proportion were White Non-Hispanic (40.7% treatment vs. 46.3% positive cases, p < 0.001), equal proportion were Black (8.2% treatment vs. 7.4% positive cases, P = 0.13), and equal proportion occurred for other race patients. Discussion Implementation of multiple systematic strategies to administer COVID-19 monoclonal antibodies resulted in an equitable race/ethnic distribution of treatment.
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Nzowa PG, Nandonde FA, Seimu SML. Moderation effects of co-operative institutions’ capabilities on the relationship between health insurance literacy and participation in health insurance among co-operative members in Tanzania. DECISION 2023. [DOI: 10.1007/s40622-023-00331-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Jenkins E, Nardo JE, Salehi S. A systematic review of the 60 year literature: Effects of outreach programs in supporting historically marginalized and first-generation, low-income students in healthcare education. PLoS One 2022; 17:e0278453. [PMID: 36454878 PMCID: PMC9714932 DOI: 10.1371/journal.pone.0278453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022] Open
Abstract
We have reviewed over 60 years of studies on healthcare education outreach programs that are aimed to support first-generation, low-income, as well as underrepresented racial and ethnic minority groups (historically marginalized students) to pursue pre-health professions. As a systematic literature review, we present the challenges studies on healthcare education outreach programs had as three main categories: 1) Design, 2) Evaluation, and 3) Analysis. 1) Designs of studies on healthcare education outreach programs often lacked theoretical foundations whereby a) the interventions did not present theories underlying a causal mechanism of inequity in health professions; and/or 1b) the defined outcome measures were not clearly aligned with the problem the intervention tried to address. 2) Evaluations of studies on healthcare education outreach programs were not always conducted effectively whereby: 2a) controlled groups were commonly absent for comparison with the intervention group; and/or 2b) post measures were solely used without pre-measures. 3) Analyses of studies on healthcare education outreach programs were not adequate whereby: 3a) the response rates and effect size were commonly low; and/or 3b) qualitative results commonly did not supplement quantitative results. Overall, our findings reveal studies on healthcare education outreach programs have common challenges that hinder the reliability of their effects supporting historically marginalized students in pursuing pre-health professions. To address such challenges with studies on healthcare education outreach programs aimed at supporting historically marginalized students, we created a decision flow chart for researchers to ask themselves: 1) how is the design guided by theoretical goals; 2) how are measurements used to evaluate success; and 3) how does the analysis lead to reliable results?
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Affiliation(s)
- Eric Jenkins
- Graduate School of Education, Stanford University, Stanford, California, United States of America
| | - Jocelyn Elizabeth Nardo
- Graduate School of Education, Stanford University, Stanford, California, United States of America
- * E-mail:
| | - Shima Salehi
- Graduate School of Education, Stanford University, Stanford, California, United States of America
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Castillo AF, Davis AL, Krishnamurti T. Using implementation science frameworks to translate and adapt a pregnancy app for an emerging Latino community. BMC Womens Health 2022; 22:386. [PMID: 36131336 PMCID: PMC9490971 DOI: 10.1186/s12905-022-01975-9] [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: 04/13/2022] [Accepted: 09/09/2022] [Indexed: 12/02/2022] Open
Abstract
Background Digital mobile health (mHealth) applications are a popular form of prenatal education and care delivery in the U.S.; yet there are few Spanish language options for native speakers. Furthermore, existing applications do not consider cultural differences and disparities in healthcare access, including those specific to emerging Latino communities. Objective To adapt and translate an English-language pregnancy mobile health app to meet the language and cultural needs of Spanish-speaking Latino immigrants living in the United States. Methods We use a multi-step process, grounded in implementation science frameworks, to adapt and translate the contents of an existing pregnancy app. Interviews with stakeholders (n = 12) who advocate for the needs of pregnant individuals in an emerging Latino community were used to identify domains of possible disparities in access to prenatal care. We then conducted semi-structured interviews with peripartum Spanish-speaking Latino users (n = 14) to understand their perspectives within those domains. We identified a list of topics to create educational material for the modified app and implemented a systematic translation approach to ensure that the new version was acceptable for immigrants from different countries in Latin America. Results The interviews with stakeholders revealed seven critical domains that need to be addressed in an adapted prenatal app: language and communication, financial concerns, social support, immigration status, cultural differences, healthcare navigation, and connection to population-specific community resources that offer Spanish language services. The interviews with peripartum Spanish-speaking Latino women informed how the existing content in the app could be adjusted or built upon to address these issues, including providing information on accessing care offered in their native language and community support. Finally, we used a systematic approach to translate the existing application and create new content. Conclusion This work illustrates a process to adapt an mHealth pregnancy app to the needs of an emerging Latino community, by incorporating culturally sensitive Spanish language content while focusing on addressing existing health disparities.
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White-Williams C, Liu X, Shang D, Santiago J. Use of Telehealth Among Racial and Ethnic Minority Groups in the United States Before and During the COVID-19 Pandemic. Public Health Rep 2022; 138:149-156. [PMID: 36113138 PMCID: PMC9482875 DOI: 10.1177/00333549221123575] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The COVID-19 pandemic has propelled the use of technology for health care services delivery. Because of inequities in health care and technology access, we investigated the use of telehealth services among racial and ethnic minority groups before and during the COVID-19 pandemic. METHODS For this retrospective study, we examined the electronic health records of privately insured patients in the Healthjump database, provided by the COVID-19 Research Database Consortium. We examined 17.98 million unique visit records of 2.93 million patients from March through December 2019 and 22.17 million records of 3.55 million patients from March through December 2020. We conducted a descriptive analysis and used multiple logistic regression to examine differences in the use of telehealth services among 3 racial and ethnic groups: non-Hispanic White, non-Hispanic Black, and Hispanic people. RESULTS Telehealth visits before and during COVID-19 accounted for 8.3% and 10.9% of total visits, respectively, with a peak of 15.5% in April 2020. Pre-COVID-19, Hispanic patients had a significantly lower monthly utilization rate (5.3%) than non-Hispanic White patients (8.4%, P < .001) and non-Hispanic Black patients (10.4%, P = .001). During the pandemic study period, Hispanic patients were 41% less likely than non-Hispanic White patients to have a telehealth visit, controlling for age and sex. CONCLUSIONS The likelihood of using telehealth was lower among Hispanic patients than among non-Hispanic White and non-Hispanic Black patients during the pandemic. Culturally sensitive measures are needed to support telehealth use among the Hispanic population.
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Affiliation(s)
- Cynthia White-Williams
- Center for Aging Research, Brooks College of Health, University of North Florida, Jacksonville, FL, USA,School of Global Health Management and Informatics, University of Central Florida, Orlando, FL, USA,Cynthia White-Williams, PhD, MHA, PT, University of Central Florida, School of Global Health Management and Informatics, 12494 University Blvd, Orlando, FL 32816, USA.
| | - Xinliang Liu
- Department of Community and Population Health, Lehigh University, Bethlehem, PA, USA
| | - Di Shang
- Coggin College of Business, University of North Florida, Jacksonville, FL, USA
| | - Jared Santiago
- Center for Aging Research, Brooks College of Health, University of North Florida, Jacksonville, FL, USA
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Stojisavljević S, Đikanović B, Vončina L, Scott K, Shroff Z, Manigoda D, Štrbac S, Bosančić B, Mathauer I. The challenge of ensuring elderly people can access their health insurance entitlements: a mixed methods study on the Republic of Srpska's Protector of Patients' Health Insurance Entitlements. BMJ Glob Health 2022; 7:bmjgh-2022-009373. [PMID: 36109016 PMCID: PMC9476123 DOI: 10.1136/bmjgh-2022-009373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/18/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Healthcare utilisation requires knowing one's entitlements and how to access them (navigation) and having access to grievance redressal when entitlements are denied. To ensure citizen access to and use of health insurance entitlements, the Health Insurance Fund established an initiative called the Protector of Patients' Health Insurance Entitlements (PPHIE). PPHIEs are supposed to provide patient navigation and grievance redressal services. This paper explores to what extent this initiative meets its objectives and is used by the elderly in rural areas. METHODS This study employed a mixed methods approach. We conducted in-depth interviews with elderly patients in rural areas, PPHIEs, health providers and health insurance managers (N=39), as well as focus groups (N=5) and a household survey (N=715) with elderly rural patients. Qualitative data were analysed using content analysis, and the household survey results were analysed using descriptive statistics. RESULTS The majority of elderly patients were not aware of the PPHIE initiative and instead received patient navigation support from their healthcare providers. The PPHIE programme was poorly publicised among the population. Although PPHIEs had a mandate to pursue grievance redressal they rarely did so, and their role in the system was more symbolic than functional. CONCLUSION While healthcare providers have (by default) filled the navigation role left by inactive PPHIEs, the grievance redressal role remains unfilled. Information about health insurance entitlements and access to grievance redressal must be provided through visible, accessible and efficient mechanisms that should be continuously monitored and improved.
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Affiliation(s)
- Stela Stojisavljević
- Public Health Institute of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina .,Department of Public Health, University of Banja Luka Faculty of Medicine, Banja Luka, Bosnia and Herzegovina
| | - Bosiljka Đikanović
- Institute of Social Medicine, University of Belgrade Faculty of Medicine, Beograd, Serbia
| | | | - Kerry Scott
- Independent Research Consultant, Baltimore, Maryland, USA.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Zubin Shroff
- WHO Alliance for Health Policy and Systems Research, Geneva, Switzerland
| | - Dijana Manigoda
- Public Health Institute of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Savka Štrbac
- Public Health Institute of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Borut Bosančić
- Faculty of Agriculture, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
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Perez-Brescia M, Beck CT, Alicea Planas J, Newlin-Lew KH, Whittemore R, Juarez A. Famalismo Primero and Puerta Cerrada in Self-Managing Diabetes Among Hispanics: A Qualitative Meta-Synthesis. J Transcult Nurs 2022; 33:666-674. [DOI: 10.1177/10436596221109834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Type 2 diabetes (T2D) prevalence is increasing at concerning rates for Hispanics. Researchers have attempted to understand why through quantitative or qualitative studies. This meta-synthesis examines qualitative studies concerning barriers and facilitators that Hispanics face while managing their diabetes. Method: Noblit and Hare’s (1988) defined method of analysis was used to synthesize 15 qualitative studies on Hispanics’ diabetes self-management. Results: Findings revealed two themes: (a) famalismo primero and (b) puerta cerrada, translating to family first and closed door, respectively. In famalismo primero, Hispanics with T2D prioritize family, and receive support, motivation, and knowledge from them first; puerta cerrada is tied to barriers such as cost of services and patient–provider relationships. Discussion: Inclusion of family in diabetes self-management provides support and motivation for Hispanics. Hispanics experience barriers to access health care that may interfere with diabetes self-management, which need to be addressed to promote health equity.
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Affiliation(s)
| | | | | | | | | | - A. Juarez
- University of Texas Medical Branch, Galveston, USA
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Hua HU, Rayess N, Li AS, Do D, Rahimy E. Quality, Readability, and Accessibility of Online Content From a Google Search of “Macular Degeneration”: Critical Analysis. JOURNAL OF VITREORETINAL DISEASES 2022; 6:437-442. [PMID: 37009540 PMCID: PMC9954772 DOI: 10.1177/24741264221094683] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This work aims to assess the quality, accountability, readability, accessibility, and presence of Spanish translation in online material through a Google search of “macular degeneration”. Methods: In this retrospective cross-sectional analysis of website results from a Google search of “macular degeneration”, the quality and accountability for each website were assessed using the DISCERN criteria and the Health on the Net Foundation Code of Conduct (HONcode) principles. All 31 sites were independently graded by 2 ophthalmologists. Readability was evaluated using an online tool. The presence of accessibility features on the website and Spanish translation was recorded. The primary outcome measure was the DISCERN and HONcode quality and accountability scores of each website. Secondary outcome measures included the readability, accessibility, and presence of Spanish translation. Results: The mean ± SD of each criterion across all 15 DISCERN questions was 2.761 ± 0.666 (out of 5). The mean HONcode score for all websites was 7.355 ± 3.123. The mean consensus reading grade level was 10.258 ± 2.49. There were no statistically significant differences in any score between the top 5 websites and the bottom 26 websites evaluated. Accessibility was available on 10 of 31 websites. Spanish translation was available on 10 of 31 websites. Conclusions: The top 5 websites that appeared on a Google search did not have better quality or readability of online content. Improving quality, accountability, and readability can help improve patients’ health literacy regarding macular degeneration.
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Affiliation(s)
- Hong-Uyen Hua
- Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Nadim Rayess
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Angela S. Li
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Diana Do
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Ehsan Rahimy
- Palo Alto Medical Foundation, Department of Ophthalmology, Palo Alto, CA, USA
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14
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Racial/Ethnic Disparities in Health and Life Insurance Denial Due to Cancer among Cancer Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042166. [PMID: 35206354 PMCID: PMC8872206 DOI: 10.3390/ijerph19042166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 11/16/2022]
Abstract
This study examined racial/ethnic differences in health/life insurance denial due to cancer among cancer survivors after the passage of the Affordable Care Act (ACA). Behavioral Risk Factor Surveillance System data were obtained from 2012–2020. The dependent variable asked: “Were you ever denied health insurance or life insurance coverage because of your cancer?” Cancer survivors were included if they were diagnosed with cancer after the Affordable Care Act (N = 14,815). Unadjusted and adjusted logistic regressions for age, sex, income, and employment provided odds ratios of insurance denial due to cancer across racial/ethnic groups: Non-Hispanic White, Black, and Other/mixed race; and Hispanic. Statistically significant differences (p < 0.05) were found between those who were denied or not denied insurance across sex, age, race/ethnicity, income, and employment. Adjusted regressions found significantly higher odds ratios of insurance denial for Blacks (OR: 3.00, 95% CI: 1.77, 5.08), Other/mixed race (OR: 2.16, 95% CI: 1.16, 4.02), and Hispanics (OR: 2.13, 95% CI: 1.02, 4.42) compared to Whites. Differences were observed across sex, income, and employment. Cancer survivors report racial/ethnic disparities in health and life insurance denial due to their cancer despite policy changes. This may be harmful for those who are already financially vulnerable due to their cancer diagnosis and exacerbate racial/ethnic cancer disparities.
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Kim SJ, Medina M, Delgado R, Miller A, Chang J. Healthcare Utilization Disparities Among Lung Cancer Patients in US Hospitals During 2010–2014: Evidence from the US Hispanic Population’s Hospital Charges and Length of Stay. Int J Gen Med 2022; 15:1329-1339. [PMID: 35173471 PMCID: PMC8841460 DOI: 10.2147/ijgm.s348159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/26/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose There is a lack of research focused on understanding the differences in the healthcare utilization of lung cancer patients between ethnic groups. This study aims to characterize disparities in healthcare utilization for Hispanic lung cancer patients compared to non-Hispanic patients. Methods National Inpatient Sample was used to identify nationwide lung cancer patients (n=141,675, weighted n=702,878) from 2010 to 2014. We examined the characteristics of the study sample by race (Hispanic vs non-Hispanic) and its association with healthcare utilization, measured by discounted hospital charges and length of stay. Multivariate survey regression models were used to identify predictors by racial groups. Results Among 702,878 lung cancer patients, 5.1% were Hispanic. Descriptive statistics showed that Hispanics have higher hospital charges and length of stay. Survey regression results also suggested that Hispanic lung cancer patients were associated with higher hospital charges (26.6%) and length of stay (3.5%) than non-Hispanic lung cancer patients. Subgroup analysis displayed a similar trend to the full model. Conclusion Healthcare utilization disparities may exist for lung cancer Hispanic patients due to insurance status and early detection. Thus, our findings support providing financial assistance and targeted programs for minority patients. Future health policy consideration should be given to those vulnerable populations where limited healthcare resources are available.
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Affiliation(s)
- Sun Jung Kim
- Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, Republic of Korea
- Center for Healthcare Management Science, Soonchunhyang University, Asan, Republic of Korea
- Department of Software Convergence, Soonchunhyang University, Asan, Republic of Korea
| | - Mar Medina
- School of Pharmacy, University of Texas at El Paso, El Paso, TX, USA
| | - Rigoberto Delgado
- Department of Healthcare Administration, College of Business, Texas Woman’s University, Denton, TX, USA
| | - Anastasia Miller
- Department of Healthcare Administration, College of Business, Texas Woman’s University, Denton, TX, USA
| | - Jongwha Chang
- Department of Healthcare Administration, College of Business, Texas Woman’s University, Denton, TX, USA
- Correspondence: Jongwha Chang, Tel +1940-898-2899, Email
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16
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Yagi BF, Luster JE, Scherer AM, Farron MR, Smith JE, Tipirneni R. Association of Health Insurance Literacy with Health Care Utilization: a Systematic Review. J Gen Intern Med 2022; 37:375-389. [PMID: 34027605 PMCID: PMC8141365 DOI: 10.1007/s11606-021-06819-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 04/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Given increasing numbers of people experiencing transitions in health insurance due to declines in employer-sponsored insurance and changes in health policy, the understanding and application of health insurance terms and concepts (health insurance literacy) may be important for navigating use of health care. The study objective was to systematically review evidence on the relationship between health insurance literacy and health care utilization. METHODS Medline, SCOPUS, Web of Science, CINAHL, PsychInfo, Cochrane Library, and reference lists of published literature were searched in August 2019. Quantitative, qualitative, and intervention studies that assessed the association of health insurance literacy as the exposure and health care utilization as the outcome were identified, without language or date restrictions. Outcomes were independently assessed by 2-3 reviewers. RESULTS Twenty-one studies including a total of 62,416 subjects met inclusion criteria: three interventional trials, two mixed-methods studies, and sixteen cross-sectional studies. Ten of thirteen preventive care studies suggested that higher health insurance literacy was associated with greater utilization of primary care and other preventive services. Eight of nine studies of care avoidance demonstrated that individuals with lower health insurance literacy were more likely to delay or avoid care. A few studies had mixed results regarding the utilization of emergency department, inpatient, and surgical care. DISCUSSION The emerging literature in this area suggests that health insurance literacy is an important factor that can enable effective utilization of health care, including primary care and preventive services. However, the literature is limited by a paucity of studies using validated tools that broadly measure health insurance literacy (rather than testing knowledge of specific covered services). Improving health insurance literacy of the general public and increasing plain language communication of health insurance plan features at the point of health care navigation may encourage more effective and cost-conscious utilization.
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Affiliation(s)
- Brian F Yagi
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jamie E Luster
- Department of Internal Medicine, Division of General Medicine, University of Michigan, 2800 Plymouth Road, Bldg 16, Rm 419W, Ann Arbor, MI, USA
| | - Aaron M Scherer
- Department of Internal Medicine, Division of General Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Madeline R Farron
- Department of Internal Medicine, Division of General Medicine, University of Michigan, 2800 Plymouth Road, Bldg 16, Rm 419W, Ann Arbor, MI, USA
| | - Judith E Smith
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Renuka Tipirneni
- Department of Internal Medicine, Division of General Medicine, University of Michigan, 2800 Plymouth Road, Bldg 16, Rm 419W, Ann Arbor, MI, USA.
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
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17
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Williams CB, Pensa MA, Olson DP. Health insurance literacy in community health center staff. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-020-01250-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
Abstract
Aim
This systematic literature review aimed to find and summarize the content and conceptual dimensions assessed by quantitative tools measuring Health Insurance Literacy (HIL) and related constructs.
Methods
Using a Peer Review of Electronic Search Strategy (PRESS) and the PRISMA guideline, a systematic literature review of studies found in ERIC, Econlit, PubMed, PsycInfo, CINAHL, and Google Scholar was performed in April 2019. Measures for which psychometric properties were evaluated were classified based on the Paez et al. conceptual model for HIL and further assessed using COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) Risk of Bias checklist and criteria for good measurement properties.
Results
Out of 123 original tools, only 19 were tested for psychometric and measurement properties; 18 of these 19 measures were developed and used in the context of Medicare. Four of the found measures tested for psychometric properties evaluated all four domains of HIL according to Paez et al.’s conceptual model; the rest of the measures assessed three (3), two (8), or one domain (4) of HIL.
Conclusion
Most measurement tools for HIL and related constructs have been developed and used in the context of the USA health insurance system, primarily in Medicare, while there is a paucity of measurement tools for private health insurances and from other countries. Furthermore, there is a lack of conceptual consistency in the way HIL is measured. Standardization of HIL measurement is crucial to further understand the role and interactions of HIL in other insurance contexts.
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19
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Barriers to Accessing Medical Care for Hispanic Individuals With Craniofacial Conditions. Plast Surg Nurs 2021; 40:236-243. [PMID: 33259425 DOI: 10.1097/psn.0000000000000351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the United States, having limited access to health care has been an ongoing concern that could cause detrimental effects for minority populations, specifically the Hispanic population. Numerous barriers to accessing health care were identified for both pediatric and adult Hispanic patients who were born with craniofacial conditions. Barriers that were determined to impact Hispanic patients with craniofacial conditions from receiving medical and health services included language and communication, patient-health care provider relationships, socioeconomic status and finances, insurance status, timely access to appointments, citizenship and immigration status, and lack of family and social support. Interventions for these barriers were also proposed to increase support for Hispanic patients. Lamentably, there is scant research that investigates how these barriers affect this special population, despite the limitations that they have in their ability to access health care. In addition, these barriers to treatment have dire consequences for individuals with craniofacial conditions. The findings and proposed interventions discussed in this review article provide measures to minimize these barriers and define ways to benefit Hispanic patients with craniofacial conditions.
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20
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Langan E, Kamal AH, Miller KEM, Kaufman BG. Comparing Palliative Care Knowledge in Metropolitan and Nonmetropolitan Areas of the United States: Results from a National Survey. J Palliat Med 2021; 24:1833-1839. [PMID: 34061644 DOI: 10.1089/jpm.2021.0114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Despite recent growth in access to specialty palliative care (PC) services, awareness of PC by patients and caregivers is limited and misconceptions about PC persist. Identifying gaps in PC knowledge may help inform initiatives that seek to reduce inequities in access to PC in rural areas. Objective: We compared knowledge of PC in metropolitan and nonmetropolitan areas of the United States using a nationally representative sample of U.S. adults. Design: We used data from the 2018 Health Information National Trends Survey (HINTS) 5 Cycle 2 to compare prevalence and predictors of PC knowledge and misconceptions in nonmetropolitan and metropolitan areas as defined by the 2013 Urban-Rural Classification (URC) Scheme for Counties. We estimated the association between nonmetro status and knowledge of PC, adjusted for respondent characteristics, using multivariable logistic regression. Results: More respondents reported that they had never heard of PC in nonmetro (78.8%) than metro (70.1%) areas (p < 0.05). Controlling for other factors, nonmetro residence was associated with a 41% lower odds of PC knowledge (odds ratio [OR] = 0.59; 95% confidence interval [CI] = 0.37-0.94), and Hispanic respondents also demonstrated significantly lower odds of PC knowledge conditional on rural status (OR = 0.47; CI = 0.27-0.83). Misconceptions about PC were high in both metro and nonmetro areas. Conclusion: Awareness of PC was lower in rural and micropolitan areas compared with metropolitan areas, suggesting the need for tailored educational strategies. The reduced awareness of PC among Hispanic respondents regardless of rural status raises concerns about equitable access to PC services for this population.
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Affiliation(s)
- Erica Langan
- Trinity College of Arts and Sciences, Duke University, Durham, North Carolina, USA
| | - Arif H Kamal
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Katherine E M Miller
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina, USA
| | - Brystana G Kaufman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA.,Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina, USA
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21
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Tambling RR, D’Aniello C, Russell BS. Health Insurance Literacy among Caregivers of Substance Using Young Adults. ALCOHOLISM TREATMENT QUARTERLY 2021. [DOI: 10.1080/07347324.2021.1927926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Rachel R. Tambling
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Carissa D’Aniello
- Department of Community, Family, and Addiction Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Beth S. Russell
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
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22
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Barriers to Accessing Medical Care for Hispanic Individuals With Craniofacial Conditions. Plast Surg Nurs 2021; 40:73-80. [PMID: 32459754 DOI: 10.1097/psn.0000000000000302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the United States, having limited access to health care has been an ongoing concern that could cause detrimental effects for minority populations, specifically the Hispanic population. Numerous barriers to accessing health care were identified for both pediatric and adult Hispanic patients who were born with craniofacial conditions. Barriers that were determined to impact Hispanic patients with craniofacial conditions from receiving medical and health services included language and communication, patient-health care provider relationships, socioeconomic status and finances, insurance status, timely access to appointments, citizenship and immigration status, and lack of family and social support. Interventions for these barriers were also proposed to increase support for Hispanic patients. Lamentably, there is scant research that investigates how these barriers affect this special population, despite the limitations that they have in their ability to access health care. In addition, these barriers to treatment have dire consequences for individuals with craniofacial conditions. The findings and proposed interventions discussed in this review article provide measures to minimize these barriers and define ways to benefit Hispanic patients with craniofacial conditions.
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23
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Dalstrom M, Weinzimmer LG, Foulger R, Klein CJ. Medicaid expansion and accessibility to healthcare: The Illinois experience. Public Health Nurs 2021; 38:720-729. [PMID: 33778982 DOI: 10.1111/phn.12899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/04/2021] [Accepted: 03/07/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The study examined the impact that the Medicaid expansion in Illinois had upon insurance rates, access to medical care, dental care, pharmaceuticals, and mental-health counseling between rural and urban counties. DESIGN AND SAMPLE A serial cross-sectional design was used to assess the health perceptions of adults living in Illinois. MEASURES Survey data were collected in 2012 (n = 6,149) before the Medicaid expansion in Illinois and in 2015 (n = 3,532) after the expansion from rural (n = 4) and urban counties (n = 4). INTERVENTION Medicaid expansion reduced the uninsured rate in both rural (16.39%-4.87%) and urban counties (17.05%-5.2%) and improved self-reported health. It also increased access to all types of healthcare, with the biggest increase in dental coverage. RESULTS Path analysis indicated that the Medicaid expansion β = -1.03 (p < .01) and poor versus not poor β = -1.50 (p < .01) were a significant predictor to no healthcare access. Rural verses urban location was not significant (β = 0.04); however, race/ethnicity was significantly different (p < .01). CONCLUSION Findings suggest that although the expansion has increased access to care overall, those who are the most vulnerable are still not benefiting equally from the expansion. Therefore, strategies to assist high-risk adults in enrolling and using their Medicaid coverage need to developed and implemented.
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Affiliation(s)
| | - Laurence G Weinzimmer
- Caterpillar Inc. Professor of Management, Foster College of Business, Bradley University, Peoria, IL, USA
| | - Roopa Foulger
- Healthcare Analytics Department, OSF HealthCare, Peoria, IL, USA
| | - Colleen J Klein
- Center for Advanced Practice, OSF HealthCare, Peoria, IL, USA
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Low HM, Wong TP, Lee LW, Makesavanh S, Vongsouangtham B, Phannalath V, Che Ahmad A, Lee ASS. Can pictorial narration offer a solution to teacher training on the effective inclusion of students with autism spectrum disorder in low-resource settings? Investigation on knowledge and stigma change. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:1216-1233. [PMID: 33467885 DOI: 10.1177/1362361320984899] [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
LAY ABSTRACT In this study, we explored whether pictorial narration could offer a solution to teacher training on effective inclusion of students with autism spectrum disorder in the Lao People's Democratic Republic. For this purpose, pre- and post-training knowledge data were collected from 87 Laotian teachers who participated in teacher training using a pictorial narrative e-module called The Story of KhamdyTM. The teachers' knowledge test results and feedback were analyzed. The findings indicated that teachers' acceptance toward the training method had positive effects on their knowledge changes and supported the use of a pictorial narration approach in imparting knowledge about inclusive education and autism spectrum disorder to teachers in a least developed country.
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25
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Carter SP, Malte CA, Rojas SM, Hawkins EJ, Reger MA. Examination of potential disparities in suicide risk identification and follow-up care within the Veterans Health Administration. Suicide Life Threat Behav 2020; 50:1127-1139. [PMID: 33196113 PMCID: PMC7746590 DOI: 10.1111/sltb.12673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/23/2020] [Accepted: 04/06/2020] [Indexed: 11/30/2022]
Abstract
To improve the identification and intervention of suicide risk, the Veterans Health Administration implemented the use of electronic patient record flags (PRF) to indicate when a veteran is identified as high risk for suicide and to increase the clinical contacts made with the veteran. The current study utilized an intersectional approach to assess potential disparities in the likelihood of receiving a PRF and the likelihood of receiving post-PRF follow-up care among veterans with substance use disorders (SUDs). Among 458,092 veterans who received a SUD diagnosis in 2012, Black veterans were less likely to receive a PRF, although Black-disabled veterans and Black-female veterans were more likely to receive a PRF. Homelessness was related to greater likelihood of receiving a PRF and post-PRF care. Hispanic/Latinx veterans who experienced homelessness were more likely to receive post-PRF care, while disabled veterans who experienced homelessness were less likely. Hispanic/Latinx, female veterans, and Black-disabled veterans were significantly less likely to receive post-PRF care. Overall, few marginalized or intersecting identities were associated with decreased PRF or decreased follow-up care. There are opportunities for specific strategies that promote engagement in VA follow-up services for veterans identifying as Hispanic/Latinx women, disabled Black veterans, and disabled homeless veterans.
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Affiliation(s)
- Sarah P. Carter
- Seattle-Denver Center of Innovation for Veteran-Centered Value-Driven Care, VA Puget Sound Health Services,Department of Health Services, University of Washington,Uniformed Services University of the Health Sciences
| | - Carol A. Malte
- Seattle-Denver Center of Innovation for Veteran-Centered Value-Driven Care, VA Puget Sound Health Services,Center of Excellence in Substance Addiction and Treatment (CESATE), VA Puget Sound Health Care System
| | | | - Eric J. Hawkins
- Seattle-Denver Center of Innovation for Veteran-Centered Value-Driven Care, VA Puget Sound Health Services,Center of Excellence in Substance Addiction and Treatment (CESATE), VA Puget Sound Health Care System,Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA
| | - Mark A. Reger
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA,VA Puget Sound Health Services
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Smith D, Mutic A, Mac VVT, Hertzberg VS, McCauley LA. Analyzing the predictors of health care utilization in the agricultural worker population using decision tree analysis: Does language matter? Public Health Nurs 2020; 38:56-63. [PMID: 33107059 DOI: 10.1111/phn.12826] [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: 03/21/2020] [Revised: 08/28/2020] [Accepted: 10/05/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To analyze the predictors of health care utilization among respondents to the National Agricultural Worker Survey. Specifically, we hypothesized that English proficiency would predict utilization of health care services within the last 2 years. METHODS Using the 2015-2016 National Agricultural Worker Survey, we performed a secondary data analysis to analyze the predictors of health care utilization within the last 2 years in the United States' agricultural worker population. Data were cleaned and analyzed using decision tree analysis, which produced a classification tree model that was trained on 90% of the data and validated on 10%. RESULTS Exposure to English was not a predictor of health care utilization in our classification tree. The first major partition that predicted utilization was insurance status. Additional partitions were on age, gender, hypertension diagnosis, and public aid. CONCLUSIONS By partitioning on insurance status and use of public aid, the decision tree provided evidence that systemic factors are key determinants of health care utilization in the agricultural worker community. This highlights the importance of agencies that connect agricultural workers with resources that provide insurance and improve access to health care. This is especially important given that agricultural workers are one of the highest risk groups for occupational injury or death in the United States.
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Affiliation(s)
- Daniel Smith
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Abby Mutic
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Valerie V T Mac
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Vicki S Hertzberg
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Linda A McCauley
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Call KT, Conmy A, Alarcón G, Hagge SL, Simon AB. Health insurance literacy: How best to measure and does it matter to health care access and affordability? Res Social Adm Pharm 2020; 17:1166-1173. [PMID: 32952089 DOI: 10.1016/j.sapharm.2020.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Health insurance is complex, cost are continuously rising, and people are assuming more of these costs. Health insurance literacy (HIL) is related to healthcare access, yet there is no agreement about how best to measure HIL. OBJECTIVES Contrast two HIL measures. First, evaluating their association with demographic characteristics, insurance type, and health status. Second, comparing how these distinct measures relate to access, forgone care, and financial burden of health care. METHODS Data are from a 2017 telephone survey focused on health insurance coverage and access. Participants were randomly assigned either the 4-item likelihood of proactive use scale or a 4-item measure of confidence in use of insurance. Logistic regressions assess correlates of each HIL measure and their association with a range of access measures. RESULTS For both measures, 25% of insured adults report high HIL. Few demographic and health status measures are associated with high HIL and they are different for each measure. For both measures, high HIL translates into reports of having a usual source of care and confidence in getting care when needed. The HIL measures behave in opposite ways for forgone care due to costs and problems paying medical bills. Adults scoring high on the likelihood measure are more likely to forgo care and report financial burden. By contrast, adults scoring high on the confidence measure are less likely to forgo care and report burdensome medical bills. CONCLUSIONS The two measures capture different concepts and raise the question of whether reporting a likely behavior or being confident of that behavior are predictive when it is time to use health insurance. Because HIL is measured at the same time as the outcomes, we reason that the likelihood measure is capturing peoples' past experience using insurance and may result in more proactive use of insurance in the future.
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Affiliation(s)
- Kathleen Thiede Call
- University of Minnesota, School of Public Health, State Health Access Data Assistance Center 2221 University Avenue, Suite 345, Minneapolis, MN, 55414, United States.
| | - Ann Conmy
- Office of Health Policy, Office of the Assistant Secretary for Planning and Evaluation, Room 447D--Hubert H. Humphrey Building 200 Independence Avenue SW, Washington, DC, 20201, United States
| | - Giovann Alarcón
- University of Minnesota, School of Public Health, State Health Access Data Assistance Center 2221 University Avenue, Suite 345, Minneapolis, MN, 55414, United States
| | - Sarah L Hagge
- Minnesota Department of Health, Health Economics Program, Golden Rule Building 85 7th Place E, St Paul, MN, 55101, United States
| | - Alisha Baines Simon
- Minnesota Department of Health, Health Economics Program, Golden Rule Building 85 7th Place E, St Paul, MN, 55101, United States
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Greaney ML, Wallington SF, Rampa S, Vigliotti VS, Cummings CA. Assessing health professionals' perception of health literacy in Rhode Island community health centers: a qualitative study. BMC Public Health 2020; 20:1289. [PMID: 32843002 PMCID: PMC7448344 DOI: 10.1186/s12889-020-09382-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/12/2020] [Indexed: 11/11/2022] Open
Abstract
Background Limited health literacy is linked with poor health behaviors, limited health care access, and poor health outcomes. Improving individual and population health outcomes requires understanding and addressing barriers to promoting health literacy. Methods Using the socio-ecological model as a guiding framework, this qualitative study (Phase 1 of a larger ongoing project) explored the interpersonal and organizational levels that may impact the health literacy levels of patients seeking care at federally qualified community health centers (FQCHCs) in Rhode Island. Focus groups were conducted with FQCHC employees (n = 37) to explore their perceptions of the health literacy skills of their patients, health literacy barriers patients encounter, and possible strategies to increase health literacy. The focus groups were audio-recorded and transcribed, and transcripts were coded using a process of open, axial, and selective coding. Codes were grouped into categories, and the constant comparative approach was used to identify themes. Results Eight unique themes centered on health literacy, sources of health information, organizational culture’s impact, challenges from limited health literacy, and suggestions to ameliorate the impact of limited health literacy. All focus group participants were versed in health literacy and viewed health literacy as impacting patients’ health status. Participants perceived that some patients at their FQCHC have limited health literacy. Participants spoke of themselves and of their FQCHC addressing health literacy through organizational- and provider-level strategies. They also identified additional strategies (e.g., training staff and providers on health literacy, providing patients with information that includes graphics) that could be adopted or expanded upon to address and promote health literacy. Conclusions Study findings suggest that strategies may need to be implemented at the organizational-, provider-, and patient- level to advance health literacy. The intervention phase of this project will explore intervention strategies informed by study results, and could include offering health literacy training to providers and staff to increase their understanding of health literacy to include motivation to make and act on healthy decisions and strategies to address health literacy, including the use of visual aids.
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Affiliation(s)
- Mary L Greaney
- Department of Health Studies, University of Rhode Island, Kingston, RI, 02881, USA.
| | - Sherrie F Wallington
- The George Washington School of Nursing & Milken Institute School of Public Health, Washington, DC, 20006, USA
| | - Sankeerth Rampa
- School of Business, Rhode Island College, Providence, RI, 02908-1991, USA
| | - Vivian S Vigliotti
- Robbins Institute for Health Policy & Leadership, Baylor University, Waco, TX, 76798, USA
| | - Carol A Cummings
- Department of Health & Physical Education, Feinstein School of Education and Human Development, Rhode Island College, Providence, RI, 02908-1991, USA
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Edward J, Thompson R, Jaramillo A. Availability of Health Insurance Literacy Resources Fails to Meet Consumer Needs in Rural, Appalachian Communities: Implications for State Medicaid Waivers. J Rural Health 2020; 37:526-536. [PMID: 32583893 PMCID: PMC8359253 DOI: 10.1111/jrh.12485] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose With the impending changes to state Medicaid programs and other health reform policies, it is imperative to understand the factors at play in promoting consumer health insurance literacy and health system engagement. This study examines the availability of health system and community‐based programs promoting health insurance literacy and supporting informed consumer health care decision making in rural communities in Kentucky. Methods Forty‐six health systems, community‐based providers, and outreach workers participated in 4 focus groups and 10 semistructured interviews. Descriptive and analytic coding techniques were used to identify 5 major themes and subthemes from interview and focus group transcripts. Findings Consumers were generally identified as having low health insurance literacy, especially in rural communities, serving as a barrier to accessing health care insurance and services. Participants identified their own lack of knowledge and understanding around health systems, resulting from lack of training and challenges with staying updated on constant changes in health systems and policies. Overall, consumer demand or need for health insurance literacy resources and programs far exceeded supply or availability. Constant changes in the status of Kentucky's Medicaid program and the proposed changes to eligibility, specifically work requirements and copays, have caused increased confusion among both providers and consumers. Conclusions Findings indicate a pressing need for implementing programs that provide training, tools, and resources to outreach workers to help them better assist consumers with accessing and using health insurance, especially in low‐income, rural areas. Health reform policies need to be responsive to the health insurance literacy needs and abilities of consumers.
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Affiliation(s)
- Jean Edward
- College of Nursing, University of Kentucky, Lexington, Kentucky.,Markey Cancer Center, University of Kentucky Healthcare, Lexington, Kentucky
| | | | - Andrea Jaramillo
- Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
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30
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Edward J. Effective Cost Conversations: Addressing Financial Toxicity and Cost-Related Health Literacy. Clin J Oncol Nurs 2020; 24:209-213. [PMID: 32196003 DOI: 10.1188/20.cjon.209-213] [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: 11/17/2022]
Abstract
Cancer survivors have greater risk of experiencing financial toxicity, or the undue financial burden and stress that patients face related to the costs of cancer care. Cost-related health literacy promotion should begin at the point of care with effective cost-of-care conversations that help to identify and manage patient financial needs. Nurses are uniquely positioned and often sought out as trusted sources of cost-of-care information and play a key role in engaging in effective cost conversations that help consumers to understand and manage their costs of care.
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Lu VM, Shah AH, Eichberg DG, Quinones-Hinojosa A, Esquenazi Y, Komotar RJ, Ivan ME. Geographic disparities in access to glioblastoma treatment based on Hispanic ethnicity in the United States: Insights from a national database. J Neurooncol 2020; 147:711-720. [PMID: 32236779 DOI: 10.1007/s11060-020-03480-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/26/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Access to treatment for glioblastoma (GBM) can be impacted by multiple demographic parameters. Barriers specific to the Hispanic population of the United States (US) are not fully understood. Therefore, the aim of this study was to elucidate geographic disparities for access to GBM treatment in the US Hispanic population. METHODS All GBM patients with known Hispanic ethnicity status (and Caucasian race) in the US National Cancer Database (NCDB) between the years 2005-2016 were retrospectively reviewed. Treatment statuses of surgical resection, chemotherapy, radiation therapy and triple therapy (resection, chemotherapy and radiation) were summarized, and analyzed by comparison and regression analyses over US Census regions. RESULTS A total cohort size of 40,232 Caucasian GBM patients were included, with 3,111 (8%) identifying as Hispanic. The odds of treatment by chemotherapy (OR 0.78, P < 0.01), radiation therapy (OR 0.82, P < 0.01) and triple therapy (OR 0.84, P < 0.01) were all significantly lower in the Hispanic group versus non-Hispanic group. The odds of being treated in the Hispanic group were significantly lower in multiple Census regions with respect to surgical resection (New England, OR 0.51; Mountain, OR 0.68), chemotherapy (East North Central, OR 0.77; Middle Atlantic, OR 0.71; Pacific, OR 0.77), radiation therapy (Middle Atlantic, OR 0.77) and triple therapy (New England, OR 0.49; Middle Atlantic, OR 0.87; Pacific, OR 0.84). Significant barriers to triple therapy in the Hispanic group within these regions were older age (OR 0.97; P < 0.01), treatment in a community facility (OR 0.85, P = 0.03), lack of insurance (OR 0.71, P = 0.03), yearly income < $40,227 (OR 0.69, P < 0.01), low education levels (OR 0.75, P = 0.03) and presence of co-morbidity (OR 0.82; P < 0.01). CONCLUSIONS Currently in the US, there exists heterogenous geographic disparities for Hispanic GBM patients to access different treatments compared to non-Hispanic patients. Multiple circumstances can influence access to treatment within the Hispanic community of these regions, and greater investigation with more granularity required to reveal mechanisms in which these disparities may be addressed in the future.
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Affiliation(s)
- Victor M Lu
- Department of Neurological Surgery, Lois Pope Life Center, University of Miami Miller School of Medicine, Jackson Health System, Miami, FL, USA. .,Department of Neurologic Surgery, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Ashish H Shah
- Department of Neurological Surgery, Lois Pope Life Center, University of Miami Miller School of Medicine, Jackson Health System, Miami, FL, USA
| | - Daniel G Eichberg
- Department of Neurological Surgery, Lois Pope Life Center, University of Miami Miller School of Medicine, Jackson Health System, Miami, FL, USA
| | | | - Yoshua Esquenazi
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, Lois Pope Life Center, University of Miami Miller School of Medicine, Jackson Health System, Miami, FL, USA
| | - Michael E Ivan
- Department of Neurological Surgery, Lois Pope Life Center, University of Miami Miller School of Medicine, Jackson Health System, Miami, FL, USA
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Panchap L, Safavynia SA, Tangel V, White RS. Socioeconomic Disparities in Carotid Revascularization Procedures. J Cardiothorac Vasc Anesth 2020; 34:1836-1845. [PMID: 31917077 DOI: 10.1053/j.jvca.2019.11.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/17/2019] [Accepted: 11/21/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Several studies have demonstrated healthcare disparities in postoperative outcomes after carotid endarterectomy and carotid artery stenting, including increased hospital mortality, postoperative stroke, and readmission rates. The objective of the present study was to examine the intersectionality between race/ethnicity, insurance status, and postoperative outcomes in carotid procedures. DESIGN Records of adults from 2007 to 2014 were retrospectively identified, and patients with appropriate International Classification of Diseases Ninth Revision Clinical Modification codes for carotid endarterectomy or carotid artery stenting were identified. Primary outcomes were unadjusted rates and adjusted odds ratios (aORs) of postoperative in-hospital mortality, stroke, combined stroke/mortality, and cardiovascular complications. SETTING Data were sourced from the State Inpatient Databases data from California, Florida, Kentucky, Maryland, and New York during the years 2007 to 2014. PARTICIPANTS Patients undergoing carotid revascularization procedures. INTERVENTIONS The effects of race and insurance status as independent variables and as effect modifiers on postoperative outcomes. MEASUREMENTS AND MAIN RESULTS Multivariable logistic regression models were used to examine the associations between race and/or insurance status with respect to study outcomes. Race, but not payer status, was significantly associated with adverse outcomes after carotid artery procedures, with blacks, Hispanics, and other non-Caucasian races demonstrating a significantly greater risk of postoperative stroke and mortality (aOR range 1.24-1.59). This relationship persisted even when stratified by procedure type (aOR range 1.25-1.56) and symptomatology (aOR range 1.51-1.63). CONCLUSIONS These results suggest that disparities in postoperative outcomes after carotid artery procedures are associated with race but not with primary insurance status. Multiple contributing factors exist, including racial inequities in prevalence of comorbidities, health literacy, and procedure type performed.
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Affiliation(s)
- Latha Panchap
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY
| | | | - Virginia Tangel
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY
| | - Robert S White
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY.
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Edward J, Wiggins A, Young MH, Rayens MK. Significant Disparities Exist in Consumer Health Insurance Literacy: Implications for Health Care Reform. Health Lit Res Pract 2019; 3:e250-e258. [PMID: 31768496 PMCID: PMC6831506 DOI: 10.3928/24748307-20190923-01] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/20/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Health insurance literacy (HIL) is defined as a person's ability to seek, obtain, and understand health insurance plans, and once enrolled use their insurance to seek appropriate health care services. Objective: The objectives of this study were to assess sociodemographic disparities in HIL, including knowledge of health insurance terms and costs, and confidence in using insurance to access health care in a nationally representative adult sample. Methods: We conducted a secondary data analysis of the Health Reform Monitoring Survey, which included 15,168 adults age 18 years and older who responded to surveys in the third quarter of 2015 and first quarter of 2016. Rao-Scott chi-square tests and weighted logistic regression were used for analysis. Key Results: The majority of our sample (51%) reported having inadequate HIL as measured by knowledge of basic insurance terms, and close to one-half (48%) had low confidence in using their insurance to access health care. Logistic regression analysis indicated significant disparities in HIL, with multiple groups identified as being at higher risk for having inadequate HIL (as measured by both knowledge and use of health insurance). These included young adults, women, those with Hispanic ethnicity, those who were not U.S. citizens, and those who were currently unmarried. Also identified to be at risk were those who are unemployed, uninsured, and enrolled in public health insurance plans, and those with lower levels of education and income. Most had inadequate knowledge of their annual out-of-pocket costs and insurance plan's deductible amounts. Conclusions: One-half of U.S. adults rate themselves as having inadequate HIL. Sociodemographic disparities in self-reported HIL underscore the need for increased consumer education, as well as efforts to simplify the health care system by promoting value-based care, supporting delivery system reforms, and designing services to be responsive to consumer HIL needs and abilities. [HLRP: Health Literacy Research and Practice. 2019;3(4):e250–e258.] Plain Language Summary: In a nationally representative sample of 15,168 adults, the majority had low knowledge about basic health insurance terms and had difficulty using health insurance to access needed health care services. These findings indicate that health insurance literacy is a major concern in our community that disproportionately affects some underserved groups more than others, including young adults, groups with low-income, and people who are uninsured.
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Affiliation(s)
- Jean Edward
- Address correspondence to Jean Edward, PhD, RN, College of Nursing, University of Kentucky, 751 Rose Street, Room 557, Lexington, KY 40536;
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Patel MR, TerHaar L, Smith A, Tariq M, Worthington K, Hinton J, Lichtenstein R. Knowledge of Health Insurance Terms and the Affordable Care Act in Racially and Ethnically Diverse Urban Communities. J Immigr Minor Health 2019; 22:456-466. [PMID: 31363888 DOI: 10.1007/s10903-019-00924-3] [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: 11/26/2022]
Abstract
Confusion around health insurance reforms persist. The purpose of this study was to assess demographic differences in Affordable Care Act (ACA) and health insurance knowledge in a multi-ethnic urban sample. Data came from 243 adults from racial/ethnic communities. Participants were asked about elements of health insurance and the ACA. Generalized linear and logistic regression models were used to examine relationships between demographic predictors and knowledge domains. Female gender (p < 0.05) and Latino/Hispanic race/ethnicity (p < 0.001) were most predictive of lower eligibility knowledge, while non-citizen with residency status (p < 0.001) and other/not declared residency status (p < 0.001) were most predictive of lower insurance coverage knowledge. No demographic factors predicted enrollment knowledge. Latino/Hispanic race/ethnicity (p < 0.01) was most predictive of not knowing that more people can get insurance because of the ACA. In conclusion, there is variation in health insurance and ACA-related knowledge in multi-ethnic populations. More compatible health communication interventions are needed to support outreach to key demographic groups.
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Affiliation(s)
- Minal R Patel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
| | - Lindsay TerHaar
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | - Alyssa Smith
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | - Madiha Tariq
- Arab Community Center for Economic and Social Services, Dearborn, MI, USA
| | - Katherine Worthington
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | - Jacquetta Hinton
- Health Disparities Reduction/Minority Health Section, Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Richard Lichtenstein
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Chang EC, Chang OD, Lucas AG, Li M, Beavan CB, Eisner RS, McManamon BM, Rodriguez NS, Katamanin OM, Bourke EC, de la Fuente A, Cardeñoso O, Wu K, Yu EA, Jeglic EL, Hirsch JK. Depression, Loneliness, and Suicide Risk among Latino College Students: A Test of a Psychosocial Interaction Model. SOCIAL WORK 2019; 64:51-60. [PMID: 30395325 DOI: 10.1093/sw/swy052] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/03/2018] [Indexed: 06/08/2023]
Abstract
This study tested a psychosocial model of suicide risk in a sample of 156 Latino college students. Specifically, depression and loneliness were hypothesized to be important predictors of suicide risk (namely, hopelessness and suicidal behaviors) in Latino students. Results of conducting regression analyses indicated that, independent of age and gender, depression and loneliness were significant predictors of both indices of suicide risk examined in the present study. It is noteworthy that within the psychosocial predictor set of depression and loneliness, depression was consistently found to be nearly twice as strong a predictor than was loneliness. Moreover, we found evidence for a significant depression-loneliness interaction effect in predicting suicide risk. That is, the highest level of suicide risk was found among dysphoric Latino students who were also socially isolated. Our findings indicate that depression and loneliness are important factors to consider in understanding suicide risk among Latino college students.
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Affiliation(s)
- Edward C Chang
- Edward C. Chang, PhD, is professor; Olivia D. Chang, BA, is research associate; and Abigael G. Lucas, MS, is a graduate student, Department of Psychology, University of Michigan, Ann Arbor. Mingqi Li, BA, is a graduate student, DePaul University, Chicago. Collin B. Beavan, BA; Rachel S. Eisner, BA; Brianna M. McManamon, BA; Natalia S. Rodriguez, BA; Olivia M. Katamanin, BA; and Eliza C. Bourke, BA, are research associates, College of Literature, Sciences & Arts, University of Michigan, Ann Arbor. Amaia de la Fuente, MSW, is a graduate student and Olga Cardeñoso, PhD, is professor, Universidad del País Vasco (University of the Basque Country), Leioa, Bizkaia, Spain. Kaidi Wu, MA, and Elizabeth A. Yu, MA, are graduate students, Department of Psychology, University of Michigan, Ann Arbor. Elizabeth L. Jeglic, PhD, is professor, John Jay College of Criminal Justice, New York. Jameson K. Hirsch, PhD, is professor, Department of Psychology, East Tennessee State University, Johnson City
| | - Olivia D Chang
- Edward C. Chang, PhD, is professor; Olivia D. Chang, BA, is research associate; and Abigael G. Lucas, MS, is a graduate student, Department of Psychology, University of Michigan, Ann Arbor. Mingqi Li, BA, is a graduate student, DePaul University, Chicago. Collin B. Beavan, BA; Rachel S. Eisner, BA; Brianna M. McManamon, BA; Natalia S. Rodriguez, BA; Olivia M. Katamanin, BA; and Eliza C. Bourke, BA, are research associates, College of Literature, Sciences & Arts, University of Michigan, Ann Arbor. Amaia de la Fuente, MSW, is a graduate student and Olga Cardeñoso, PhD, is professor, Universidad del País Vasco (University of the Basque Country), Leioa, Bizkaia, Spain. Kaidi Wu, MA, and Elizabeth A. Yu, MA, are graduate students, Department of Psychology, University of Michigan, Ann Arbor. Elizabeth L. Jeglic, PhD, is professor, John Jay College of Criminal Justice, New York. Jameson K. Hirsch, PhD, is professor, Department of Psychology, East Tennessee State University, Johnson City
| | - Abigael G Lucas
- Edward C. Chang, PhD, is professor; Olivia D. Chang, BA, is research associate; and Abigael G. Lucas, MS, is a graduate student, Department of Psychology, University of Michigan, Ann Arbor. Mingqi Li, BA, is a graduate student, DePaul University, Chicago. Collin B. Beavan, BA; Rachel S. Eisner, BA; Brianna M. McManamon, BA; Natalia S. Rodriguez, BA; Olivia M. Katamanin, BA; and Eliza C. Bourke, BA, are research associates, College of Literature, Sciences & Arts, University of Michigan, Ann Arbor. Amaia de la Fuente, MSW, is a graduate student and Olga Cardeñoso, PhD, is professor, Universidad del País Vasco (University of the Basque Country), Leioa, Bizkaia, Spain. Kaidi Wu, MA, and Elizabeth A. Yu, MA, are graduate students, Department of Psychology, University of Michigan, Ann Arbor. Elizabeth L. Jeglic, PhD, is professor, John Jay College of Criminal Justice, New York. Jameson K. Hirsch, PhD, is professor, Department of Psychology, East Tennessee State University, Johnson City
| | - Mingqi Li
- Edward C. Chang, PhD, is professor; Olivia D. Chang, BA, is research associate; and Abigael G. Lucas, MS, is a graduate student, Department of Psychology, University of Michigan, Ann Arbor. Mingqi Li, BA, is a graduate student, DePaul University, Chicago. Collin B. Beavan, BA; Rachel S. Eisner, BA; Brianna M. McManamon, BA; Natalia S. Rodriguez, BA; Olivia M. Katamanin, BA; and Eliza C. Bourke, BA, are research associates, College of Literature, Sciences & Arts, University of Michigan, Ann Arbor. Amaia de la Fuente, MSW, is a graduate student and Olga Cardeñoso, PhD, is professor, Universidad del País Vasco (University of the Basque Country), Leioa, Bizkaia, Spain. Kaidi Wu, MA, and Elizabeth A. Yu, MA, are graduate students, Department of Psychology, University of Michigan, Ann Arbor. Elizabeth L. Jeglic, PhD, is professor, John Jay College of Criminal Justice, New York. Jameson K. Hirsch, PhD, is professor, Department of Psychology, East Tennessee State University, Johnson City
| | - Collin B Beavan
- Edward C. Chang, PhD, is professor; Olivia D. Chang, BA, is research associate; and Abigael G. Lucas, MS, is a graduate student, Department of Psychology, University of Michigan, Ann Arbor. Mingqi Li, BA, is a graduate student, DePaul University, Chicago. Collin B. Beavan, BA; Rachel S. Eisner, BA; Brianna M. McManamon, BA; Natalia S. Rodriguez, BA; Olivia M. Katamanin, BA; and Eliza C. Bourke, BA, are research associates, College of Literature, Sciences & Arts, University of Michigan, Ann Arbor. Amaia de la Fuente, MSW, is a graduate student and Olga Cardeñoso, PhD, is professor, Universidad del País Vasco (University of the Basque Country), Leioa, Bizkaia, Spain. Kaidi Wu, MA, and Elizabeth A. Yu, MA, are graduate students, Department of Psychology, University of Michigan, Ann Arbor. Elizabeth L. Jeglic, PhD, is professor, John Jay College of Criminal Justice, New York. Jameson K. Hirsch, PhD, is professor, Department of Psychology, East Tennessee State University, Johnson City
| | - Rachel S Eisner
- Edward C. Chang, PhD, is professor; Olivia D. Chang, BA, is research associate; and Abigael G. Lucas, MS, is a graduate student, Department of Psychology, University of Michigan, Ann Arbor. Mingqi Li, BA, is a graduate student, DePaul University, Chicago. Collin B. Beavan, BA; Rachel S. Eisner, BA; Brianna M. McManamon, BA; Natalia S. Rodriguez, BA; Olivia M. Katamanin, BA; and Eliza C. Bourke, BA, are research associates, College of Literature, Sciences & Arts, University of Michigan, Ann Arbor. Amaia de la Fuente, MSW, is a graduate student and Olga Cardeñoso, PhD, is professor, Universidad del País Vasco (University of the Basque Country), Leioa, Bizkaia, Spain. Kaidi Wu, MA, and Elizabeth A. Yu, MA, are graduate students, Department of Psychology, University of Michigan, Ann Arbor. Elizabeth L. Jeglic, PhD, is professor, John Jay College of Criminal Justice, New York. Jameson K. Hirsch, PhD, is professor, Department of Psychology, East Tennessee State University, Johnson City
| | - Brianna M McManamon
- Edward C. Chang, PhD, is professor; Olivia D. Chang, BA, is research associate; and Abigael G. Lucas, MS, is a graduate student, Department of Psychology, University of Michigan, Ann Arbor. Mingqi Li, BA, is a graduate student, DePaul University, Chicago. Collin B. Beavan, BA; Rachel S. Eisner, BA; Brianna M. McManamon, BA; Natalia S. Rodriguez, BA; Olivia M. Katamanin, BA; and Eliza C. Bourke, BA, are research associates, College of Literature, Sciences & Arts, University of Michigan, Ann Arbor. Amaia de la Fuente, MSW, is a graduate student and Olga Cardeñoso, PhD, is professor, Universidad del País Vasco (University of the Basque Country), Leioa, Bizkaia, Spain. Kaidi Wu, MA, and Elizabeth A. Yu, MA, are graduate students, Department of Psychology, University of Michigan, Ann Arbor. Elizabeth L. Jeglic, PhD, is professor, John Jay College of Criminal Justice, New York. Jameson K. Hirsch, PhD, is professor, Department of Psychology, East Tennessee State University, Johnson City
| | - Natalie S Rodriguez
- Edward C. Chang, PhD, is professor; Olivia D. Chang, BA, is research associate; and Abigael G. Lucas, MS, is a graduate student, Department of Psychology, University of Michigan, Ann Arbor. Mingqi Li, BA, is a graduate student, DePaul University, Chicago. Collin B. Beavan, BA; Rachel S. Eisner, BA; Brianna M. McManamon, BA; Natalia S. Rodriguez, BA; Olivia M. Katamanin, BA; and Eliza C. Bourke, BA, are research associates, College of Literature, Sciences & Arts, University of Michigan, Ann Arbor. Amaia de la Fuente, MSW, is a graduate student and Olga Cardeñoso, PhD, is professor, Universidad del País Vasco (University of the Basque Country), Leioa, Bizkaia, Spain. Kaidi Wu, MA, and Elizabeth A. Yu, MA, are graduate students, Department of Psychology, University of Michigan, Ann Arbor. Elizabeth L. Jeglic, PhD, is professor, John Jay College of Criminal Justice, New York. Jameson K. Hirsch, PhD, is professor, Department of Psychology, East Tennessee State University, Johnson City
| | - Olivia M Katamanin
- Edward C. Chang, PhD, is professor; Olivia D. Chang, BA, is research associate; and Abigael G. Lucas, MS, is a graduate student, Department of Psychology, University of Michigan, Ann Arbor. Mingqi Li, BA, is a graduate student, DePaul University, Chicago. Collin B. Beavan, BA; Rachel S. Eisner, BA; Brianna M. McManamon, BA; Natalia S. Rodriguez, BA; Olivia M. Katamanin, BA; and Eliza C. Bourke, BA, are research associates, College of Literature, Sciences & Arts, University of Michigan, Ann Arbor. Amaia de la Fuente, MSW, is a graduate student and Olga Cardeñoso, PhD, is professor, Universidad del País Vasco (University of the Basque Country), Leioa, Bizkaia, Spain. Kaidi Wu, MA, and Elizabeth A. Yu, MA, are graduate students, Department of Psychology, University of Michigan, Ann Arbor. Elizabeth L. Jeglic, PhD, is professor, John Jay College of Criminal Justice, New York. Jameson K. Hirsch, PhD, is professor, Department of Psychology, East Tennessee State University, Johnson City
| | - Eliza C Bourke
- Edward C. Chang, PhD, is professor; Olivia D. Chang, BA, is research associate; and Abigael G. Lucas, MS, is a graduate student, Department of Psychology, University of Michigan, Ann Arbor. Mingqi Li, BA, is a graduate student, DePaul University, Chicago. Collin B. Beavan, BA; Rachel S. Eisner, BA; Brianna M. McManamon, BA; Natalia S. Rodriguez, BA; Olivia M. Katamanin, BA; and Eliza C. Bourke, BA, are research associates, College of Literature, Sciences & Arts, University of Michigan, Ann Arbor. Amaia de la Fuente, MSW, is a graduate student and Olga Cardeñoso, PhD, is professor, Universidad del País Vasco (University of the Basque Country), Leioa, Bizkaia, Spain. Kaidi Wu, MA, and Elizabeth A. Yu, MA, are graduate students, Department of Psychology, University of Michigan, Ann Arbor. Elizabeth L. Jeglic, PhD, is professor, John Jay College of Criminal Justice, New York. Jameson K. Hirsch, PhD, is professor, Department of Psychology, East Tennessee State University, Johnson City
| | - Amaia de la Fuente
- Edward C. Chang, PhD, is professor; Olivia D. Chang, BA, is research associate; and Abigael G. Lucas, MS, is a graduate student, Department of Psychology, University of Michigan, Ann Arbor. Mingqi Li, BA, is a graduate student, DePaul University, Chicago. Collin B. Beavan, BA; Rachel S. Eisner, BA; Brianna M. McManamon, BA; Natalia S. Rodriguez, BA; Olivia M. Katamanin, BA; and Eliza C. Bourke, BA, are research associates, College of Literature, Sciences & Arts, University of Michigan, Ann Arbor. Amaia de la Fuente, MSW, is a graduate student and Olga Cardeñoso, PhD, is professor, Universidad del País Vasco (University of the Basque Country), Leioa, Bizkaia, Spain. Kaidi Wu, MA, and Elizabeth A. Yu, MA, are graduate students, Department of Psychology, University of Michigan, Ann Arbor. Elizabeth L. Jeglic, PhD, is professor, John Jay College of Criminal Justice, New York. Jameson K. Hirsch, PhD, is professor, Department of Psychology, East Tennessee State University, Johnson City
| | - Olga Cardeñoso
- Edward C. Chang, PhD, is professor; Olivia D. Chang, BA, is research associate; and Abigael G. Lucas, MS, is a graduate student, Department of Psychology, University of Michigan, Ann Arbor. Mingqi Li, BA, is a graduate student, DePaul University, Chicago. Collin B. Beavan, BA; Rachel S. Eisner, BA; Brianna M. McManamon, BA; Natalia S. Rodriguez, BA; Olivia M. Katamanin, BA; and Eliza C. Bourke, BA, are research associates, College of Literature, Sciences & Arts, University of Michigan, Ann Arbor. Amaia de la Fuente, MSW, is a graduate student and Olga Cardeñoso, PhD, is professor, Universidad del País Vasco (University of the Basque Country), Leioa, Bizkaia, Spain. Kaidi Wu, MA, and Elizabeth A. Yu, MA, are graduate students, Department of Psychology, University of Michigan, Ann Arbor. Elizabeth L. Jeglic, PhD, is professor, John Jay College of Criminal Justice, New York. Jameson K. Hirsch, PhD, is professor, Department of Psychology, East Tennessee State University, Johnson City
| | - Kaidi Wu
- Edward C. Chang, PhD, is professor; Olivia D. Chang, BA, is research associate; and Abigael G. Lucas, MS, is a graduate student, Department of Psychology, University of Michigan, Ann Arbor. Mingqi Li, BA, is a graduate student, DePaul University, Chicago. Collin B. Beavan, BA; Rachel S. Eisner, BA; Brianna M. McManamon, BA; Natalia S. Rodriguez, BA; Olivia M. Katamanin, BA; and Eliza C. Bourke, BA, are research associates, College of Literature, Sciences & Arts, University of Michigan, Ann Arbor. Amaia de la Fuente, MSW, is a graduate student and Olga Cardeñoso, PhD, is professor, Universidad del País Vasco (University of the Basque Country), Leioa, Bizkaia, Spain. Kaidi Wu, MA, and Elizabeth A. Yu, MA, are graduate students, Department of Psychology, University of Michigan, Ann Arbor. Elizabeth L. Jeglic, PhD, is professor, John Jay College of Criminal Justice, New York. Jameson K. Hirsch, PhD, is professor, Department of Psychology, East Tennessee State University, Johnson City
| | - Elizabeth A Yu
- Edward C. Chang, PhD, is professor; Olivia D. Chang, BA, is research associate; and Abigael G. Lucas, MS, is a graduate student, Department of Psychology, University of Michigan, Ann Arbor. Mingqi Li, BA, is a graduate student, DePaul University, Chicago. Collin B. Beavan, BA; Rachel S. Eisner, BA; Brianna M. McManamon, BA; Natalia S. Rodriguez, BA; Olivia M. Katamanin, BA; and Eliza C. Bourke, BA, are research associates, College of Literature, Sciences & Arts, University of Michigan, Ann Arbor. Amaia de la Fuente, MSW, is a graduate student and Olga Cardeñoso, PhD, is professor, Universidad del País Vasco (University of the Basque Country), Leioa, Bizkaia, Spain. Kaidi Wu, MA, and Elizabeth A. Yu, MA, are graduate students, Department of Psychology, University of Michigan, Ann Arbor. Elizabeth L. Jeglic, PhD, is professor, John Jay College of Criminal Justice, New York. Jameson K. Hirsch, PhD, is professor, Department of Psychology, East Tennessee State University, Johnson City
| | - Elizabeth L Jeglic
- Edward C. Chang, PhD, is professor; Olivia D. Chang, BA, is research associate; and Abigael G. Lucas, MS, is a graduate student, Department of Psychology, University of Michigan, Ann Arbor. Mingqi Li, BA, is a graduate student, DePaul University, Chicago. Collin B. Beavan, BA; Rachel S. Eisner, BA; Brianna M. McManamon, BA; Natalia S. Rodriguez, BA; Olivia M. Katamanin, BA; and Eliza C. Bourke, BA, are research associates, College of Literature, Sciences & Arts, University of Michigan, Ann Arbor. Amaia de la Fuente, MSW, is a graduate student and Olga Cardeñoso, PhD, is professor, Universidad del País Vasco (University of the Basque Country), Leioa, Bizkaia, Spain. Kaidi Wu, MA, and Elizabeth A. Yu, MA, are graduate students, Department of Psychology, University of Michigan, Ann Arbor. Elizabeth L. Jeglic, PhD, is professor, John Jay College of Criminal Justice, New York. Jameson K. Hirsch, PhD, is professor, Department of Psychology, East Tennessee State University, Johnson City
| | - Jameson K Hirsch
- Edward C. Chang, PhD, is professor; Olivia D. Chang, BA, is research associate; and Abigael G. Lucas, MS, is a graduate student, Department of Psychology, University of Michigan, Ann Arbor. Mingqi Li, BA, is a graduate student, DePaul University, Chicago. Collin B. Beavan, BA; Rachel S. Eisner, BA; Brianna M. McManamon, BA; Natalia S. Rodriguez, BA; Olivia M. Katamanin, BA; and Eliza C. Bourke, BA, are research associates, College of Literature, Sciences & Arts, University of Michigan, Ann Arbor. Amaia de la Fuente, MSW, is a graduate student and Olga Cardeñoso, PhD, is professor, Universidad del País Vasco (University of the Basque Country), Leioa, Bizkaia, Spain. Kaidi Wu, MA, and Elizabeth A. Yu, MA, are graduate students, Department of Psychology, University of Michigan, Ann Arbor. Elizabeth L. Jeglic, PhD, is professor, John Jay College of Criminal Justice, New York. Jameson K. Hirsch, PhD, is professor, Department of Psychology, East Tennessee State University, Johnson City
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Ghaddar S, Byun J, Krishnaswami J. Health insurance literacy and awareness of the Affordable Care Act in a vulnerable Hispanic population. PATIENT EDUCATION AND COUNSELING 2018; 101:2233-2240. [PMID: 30220598 DOI: 10.1016/j.pec.2018.08.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 08/25/2018] [Accepted: 08/29/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The Patient Protection and Affordable Care Act (ACA) has allowed millions of Americans to obtain coverage. However, many, especially minorities, remain uninsured. With mounting evidence supporting the importance of health insurance literacy (HIL), the purpose of this cross-sectional study is to examine the association between HIL and ACA knowledge. METHODS We conducted 681 in-person interviews with participants at a community health event along the Texas-Mexico border in 2015, after the conclusion of the ACA's second enrollment period. To assess HIL, we used the Health Insurance Literacy Measure, reflecting consumers' confidence to choose, compare, and use health insurance. We assessed ACA knowledge through the following question: "How much would you say you know about this health reform law?" Logistic regression was used to examine the association between HIL and ACA knowledge after controlling for several covariates. RESULTS Almost 70% of participants knew nothing/very little about the ACA. Multivariate analyses revealed that no/very little ACA knowledge was associated with low levels of confidence "choosing health insurance plans" (OR:0.55; 95%CI:0.40-0.75) (full sample) and "comparing plans" (OR:0.56; 95%CI:0.32-0.96) (U.S.-born sub-sample). CONCLUSION No/little ACA knowledge is associated with lower levels of HIL. PRACTICE IMPLICATIONS Promoting HIL is an essential step towards improving healthcare access.
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Affiliation(s)
- Suad Ghaddar
- Department of Health and Biomedical Sciences, The University of Texas Rio Grande Valley, Edinburg, USA.
| | - Jihyun Byun
- School of Human Ecology, The University of Texas at Austin, Austin, USA.
| | - Janani Krishnaswami
- Department of Pediatrics and Preventive Medicine, The University of Texas Rio Grande Valley, Edinburg, USA.
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