Access to health insurance in the United States

Barriers to healthcare access for Arabic-speaking population in an English-speaking country

Objective:

To identify barriers to healthcare access, to assess the health literacy levels of the foreign-born Arabic speaking population in Iowa, USA and to measure their prevalence of seeking preventive healthcare services.

Methods:

A cross-sectional study of native Arabic speaking adults involved a focus group and an anonymous paper-based survey. The focus group and the Andersen Model were used to develop the survey questionnaire. The survey participants were customers at Arabic grocery stores, worshippers at the city mosque and patients at free University Clinic. Chi-square test was used to measure the relationship between the characteristics of survey participants and preventive healthcare services. Thematic analysis was used to analyze the focus group transcript.

Results:

We received 196 completed surveys. Only half of the participants were considered to have good health literacy. More than one-third of the participants had no health insurance and less than half of them visit clinics regularly for preventive measures. Two participant enabling factors (health insurance and residency years) and one need factor (having chronic disease(s)) were found to significantly influence preventive physician visits.

Conclusions:

This theory-based study provides a tool that can be used in different Western countries where Arabic minority lives. Both the survey and the focus group agreed that lacking health insurance is the main barrier facing their access to healthcare services. The availability of an interpreter in the hospital is essential to help those with inadequate health literacy, particularly new arriving individuals. More free healthcare settings are needed in the county to take care of the increasing number of uninsured Arabic speaking patients.

Increased racial differences on breast cancer care and survival in America: historical evidence consistent with a health insurance hypothesis, 1975-2001

PURPOSE

This study examined whether race/ethnicity had differential effects on breast cancer care and survival across age strata and cohorts within stages of disease.

METHODS

The Detroit Cancer Registry provided 25,997 breast cancer cases. African American and non-Hispanic white, older Medicare-eligible and younger non-eligible women were compared. Successive historical cohorts (1975-1980 and 1990-1995) were, respectively, followed until 1986 and 2001.

RESULTS

African American disadvantages on survival and treatments increased significantly, particularly among younger women who were much more likely to be uninsured. Within node positive disease all treatment disadvantages among younger African American women disappeared with socioeconomic adjustment.

CONCLUSIONS

Growth of this racial divide implicates social, rather than biological, forces. Its elimination will require high quality health care for all.

Predicting the receipt of employer-sponsored health insurance: the role of residence and other personal and workplace characteristics

Americans without health insurance constitute a significant public policy concern. Previous research has demonstrated that rural Americans are more likely to be without coverage. Beyond documenting this comparative disadvantage, however, current research has two specific deficiencies: studies have not examined whether the factors that predict the receipt of employer-sponsored health insurance are equivalent across residence categories, and few studies have used a multivariate framework to examine the predictors of the receipt of health insurance. Using data from the 1987 National Medical Expenditure Survey, the influence of residence is examined along with other variables known to be associated with an increased likelihood of receiving health insurance from an employer (specifically, seven employee and six workplace characteristics). At a bivariate level, an individual's place of residence did affect the probability of receiving health insurance from an employer, with nonmetropolitan workers least likely to receive such benefits. The influence of the employee and workplace characteristics on receipt of insurance, however, did not vary significantly by place of residence. In a multivariate model, six employee and six workplace characteristics were identified as significant predictors. These findings do not refute the existence of important residential differences in health insurance coverage, rather, they suggest that the differences are due to identifiable population and workplace characteristics that vary in their distribution by residence.

Self-care and illness response behaviors in a frontier area

Self-care and illness response to a recent medical event were examined based on a mailed questionnaire to a random sample of 416 adults in a frontier area in north-central Idaho. A total of 494 questionnaires were returned (45% response rate), and 78 were eliminated. Self-care behaviors were classified as: (1) waiting to see what would happen, (2) purchasing or taking a nonprescription medication, (3) taking a prescription medication that was on hand, (4) taking both a prescription and a nonprescription medication, (5) contacting a physician, and (6) going to a hospital. These six variables were classified into three intervention constructs of no intervention (waiting), informal intervention (self-medicating), and formal intervention (contacting a health care professional). Fifty-six percent of the respondents reported self-medicating behaviors. Correlation analysis indicated that initial self-care and illness response behaviors in this frontier area were generally appropriate. Three multiple discriminant models were tested to differentiate those people who waited, self-medicated, and contacted formal providers from those who did not. A significant model could not discriminate between those who waited and those who did not. Models for self-medicating and contacting formal providers correctly classified cases 60 to 70 percent of the time. The analyses indicate that self-medicating was more likely to be reported by younger individuals, by those who lived further from the hospital, who perceived their health status to be better, who reported less satisfaction with community health care services, and that the self-medicating was appropriate.(ABSTRACT TRUNCATED AT 250 WORDS)

Health care spending, delivery, and outcome in developed countries: a cross-national comparison

This study examines the trend of health care spending, availability and use of medical services, and aggregate health outcome of the 24 industrialized member countries of the Organization for Economic Cooperation and Development (OECD). Major differences between the United States and other OECD countries are highlighted and discussed. The results of the study demonstrate that, over the past four decades, the United States has been spending more and accomplishing less when compared with other industrialized nations. The United States needs to learn from the successful experience of other nations. Redesigning the system of health care delivery in the United States may be the only viable option to improve the quality of health care.

Market competition and the quality of nursing home care

This article identifies factors influencing the degree of competition in the nursing home market. Using data obtained from the 1987 Medicare and Medicaid Automated Certification Survey, the relationship between competition and structural and process measures of quality (registered nurse staffing and resident care management practices) is estimated by weighted two-stage least squares regression. Results suggest that the quality effects of indicators of competition vary and that market concentration may not diminish quality-based competition. Proposals for nursing home reimbursement reform are evaluated with respect to their incentives for enhancing quality, particularly in the Medicaid market segment.

Problems with expanding Medicaid for the uninsured

Many proposals for financing health care for the uninsured recommend expanding the Medicaid program. They often advocate extending Medicaid to all those under the poverty level and standardizing program benefits. However, the proposals have ignored important problems that must be resolved if the plans are to be successfully implemented, the most serious being the fiscal impacts that such proposals would have on states. The current Medicaid matching formula fails to reflect either the size of a state's Medicaid program or its ability to pay for it. As a result, the proportional fiscal effort that expansion proposals would require of states would greatly exceed that required of the federal government. Additionally, the fiscal impact would vary widely and have little relationship to a state's current Medicaid program generosity. Besides fiscal problems, significant differences exist between Medicaid and private plans in the areas of benefits, cost sharing, managed care, cost containment, and provider payment. Under a national system of health care, these differences would limit program economies, and create problems with perceived equity, continuity of care, and migration effects.

Innovation in primary care: community health services in Mexico and the United States

Providing adequate health care to a nation's citizens is a challenge in every country. Despite large differences in wealth, health care organization, and health politics, both Mexico and the United States undertook similar efforts to expand primary care to previously underserved populations during the past 30 years. This study analyzes common antecedents, contexts of change, elements of the innovations, problems with entrenched interests, and resources that have allowed both programs to survive in difficult environments. We show that new forms of primary health care can face similar problems and prospects in very different countries because of similar political, bureaucratic, and economic limitations.

Injuries in working populations: black-white differences

BACKGROUND

Although "accidents and adverse effects" mortality is higher among Blacks than Whites, annual injury rates reported in the National Health Interview Survey (NHIS) are lower among Blacks. We evaluated the influence of sociodemographic risk factors on injury rates among working adults.

METHODS

NHIS data from 1983 through 1987 for currently working adults were used. Methods were developed to estimate standard errors using data from different sample frames and sample sizes.

RESULTS

Working Blacks had fewer reported injuries requiring medical attention or restriction of usual activities than working Whites (22.0 vs 27.0 per 100 persons per year). The difference was pronounced among younger adults in both sexes and among both poor and nonpoor. However, age, sex, and income could not completely explain racial differentials. "At-work" injury rates (36% of all injury episodes) were similar for Blacks and Whites (9.2 vs 9.9 per 100 persons per year), except low-income Blacks and Blacks in service or blue-collar occupations had nonsignificantly smaller at-work injury rates.

CONCLUSION

Possible reporting biases could not be completely eliminated. However, available evidence does not rule out a true difference in injury rates by race, highlighting the complexity of understanding the etiology of injuries and, hence, developing public health programs to prevent injuries.