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Abstract
The Affordable Care Act (ACA) was the most significant expansion of health coverage since Medicare and Medicaid were enacted. The law resulted in approximately 13–20 million uninsured persons gaining coverage. Despite these gains, the ACA has numerous shortcomings. For progressives, the ACA was a unique opportunity to provide access to high-quality, comprehensive, equitable health coverage to all persons living in the United States. Using this perspective as our framework, in this review we highlight some of the limitations of the ACA and potential areas for refinement. We conclude that the ACA fell far short of the goal of achieving universal coverage and that the coverage made available through the ACA was not equitable. In addition, the ACA expanded coverage by building onto a highly fragmented, inefficient, and costly health system. Thus, it did little to control health costs. A more fiscally prudent approach would have been built upon more successful existing programs, such as a Medicare for All.
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Affiliation(s)
- Olveen Carrasquillo
- Division of General Internal Medicine, University of Miami Miller School of Medicine, Miami, Florida 33136
| | - Michael Mueller
- Division of General Internal Medicine, University of Miami Miller School of Medicine, Miami, Florida 33136
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Baezconde-Garbanati L, Portillo CJ, Garbanati JA. Disparities in Health Indicators for Latinas in California. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2016. [DOI: 10.1177/0739986399213007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study analyzes disparities in selected health indicators for Latinas when compared to non-Latina Whites, and other population groups in the United States, and as available in Mexico. A review and secondary analyses of government and other data were conducted as an extension of previous research. Data revealed that the population of Latinas, although youthful on average, are composed of an increasingly large group of poor women who in their middle years (45-64), and in rural communities, display high cardiac risk, high rates of diabetes, and cervical cancer. This picture calls for special attention, in particular to Latinas without health insurance. Further research, policies that protect women’s health, and culturally competent prevention services are needed to address these health disparities and the complexities of Latina health in California.
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Jun J, Oh KM. Framing risks and benefits of medical tourism: a content analysis of medical tourism coverage in Korean American community newspapers. JOURNAL OF HEALTH COMMUNICATION 2015; 20:720-727. [PMID: 25942506 DOI: 10.1080/10810730.2015.1018574] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study examines Korean American community newspapers' representation of risks and benefits involved with medical tourism offered in Korea. Using framing theory, this research attempts to explain Korean Americans' highly positive perceptions and high willingness to use health and medical services in Korea through medical tourism rather than using such services in the United States. The result of content analyses indicated that Korean American community newspapers are rarely engaged in risk communication and lack sufficient information about potential risks of medical tourism while emphasizing diverse benefits. Korean ethnic media, as the primary source of health communication for Korean Americans, should provide more reliable health and medical information for the population's appropriate health management.
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Affiliation(s)
- Jungmi Jun
- a Department of Communication , Wayne State University , Detroit , Michigan , USA
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Oh KM, Jacobsen KH. Colorectal cancer screening among Korean Americans: a systematic review. J Community Health 2014; 39:193-200. [PMID: 23982772 DOI: 10.1007/s10900-013-9758-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The incidence of colorectal cancer (CRC) among Korean Americans (KAs) has increased in recent years, even as the rate in nearly ever other population group in the United States has decreased. Reversing this trend will require improving screening rates, but a variety of sociocultural factors may inhibit this goal. We conducted a systematic review of the published literature on cancer screening among KAs, and identified thirteen eligible studies that examined CRC screening. KAs have CRC screening rates that are significantly lower than the national average. Only about one in four KAs ages 50 and older reports having ever had a fecal ocult blood test (FOBT) and only about 40 % have ever had a sigmoidoscopy or colonoscopy. KA adults are also significantly less likely than the general US population to say they have heard of FOBT, sigmoidoscopy, or colonoscopy. In the KA population, screening rates are higher among adults with higher socioeconomic status, greater acculturation to the United States, more cancer knowledge, more social support, and better access to healthcare services. Improving cultural and financial access to health education and healthcare services may increase CRC screening among KAs and reduce the incidence of the disease.
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Affiliation(s)
- Kyeung Mi Oh
- School of Nursing, George Mason University, 4400 University Drive MS 3C4, Fairfax, VA, 22030, USA,
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Oh KM, Zhou QP, Kreps G, Kim W. The influences of immigration on health information seeking behaviors among Korean Americans and Native Koreans. HEALTH EDUCATION & BEHAVIOR 2013; 41:173-85. [PMID: 23943681 DOI: 10.1177/1090198113496789] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Korean Americans (KAs) have low screening rates for cancer and are often not well informed about their chronic diseases. Reduced access to health-related information is one reason for gaps in knowledge and the widening health disparities among minority populations. However, little research exists about KAs' health information seeking behaviors. Guided by the Structural Influence Model, this study examines the influence of immigration status on KAs' trust in health information sources and health information seeking behaviors. Cross-sectional surveys were conducted in the Washington, D.C., metropolitan area as well as in the Gwangju metropolitan city in South Korea during 2006-2007. Two hundred and fifty-four KAs and 208 native Koreans who were 40 years of age or older completed the surveys. When comparing native Koreans to KAs, we found KAs were 3 times more likely to trust health information from newspapers or magazines (odds ratio [OR] = 3.13; 95% confidence interval [CI] = 1.49-6.54) and 11 times more likely to read the health sections of newspapers or magazines (OR = 11.35; 95% CI = 3.92-32.91) in multivariate adjusted models. However, they were less likely to look for health information from TV (OR = 0.29; 95% CI = 0.12-0.72) than native Koreans. Our results indicate that immigration status has profound influences on KAs' health information seeking behaviors. Increasing the availability of reliable and valid health information from printed Korean language magazines or newspapers could have a positive influence on increasing awareness and promoting screening behaviors among KAs.
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McComish JF, Groh CJ, Moldenhauer JA. Development of a Doula Intervention for Postpartum Depressive Symptoms: Participants' Recommendations. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2013; 26:3-15. [DOI: 10.1111/jcap.12019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Armstrong GT, Pan Z, Ness KK, Srivastava D, Robison LL. Temporal trends in cause-specific late mortality among 5-year survivors of childhood cancer. J Clin Oncol 2010; 28:1224-31. [PMID: 20124180 DOI: 10.1200/jco.2009.24.4608] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Five-year survival rates for childhood cancer have improved over the past four decades. However, it is unknown whether changes in primary cancer therapy have improved rates of long-term (> 5 years from diagnosis) durable remissions and reduced treatment-related deaths. We investigated changes in patterns of late mortality over time and cause-specific attribution of late-mortality among 5-year survivors. PATIENTS AND METHODS Using data from the Surveillance, Epidemiology and End Results (SEER) population-based registry, we assessed all-cause and cause-specific (recurrence/progression of primary disease, external cause, and nonrecurrence/nonexternal cause) late mortality during four consecutive time periods from 1974 through 2000 among 26,643 5-year survivors of childhood cancer. RESULTS All-cause late mortality improved during more recent eras, dropping from 7.1% (95% CI, 6.4% to 7.8%) among children diagnosed during 1974 to 1980 to 3.9% (95% CI, 3.3% to 4.4%) among children diagnosed during 1995 to 2000 (P < .001), largely because of reduced mortality from recurrence or progression. While there was no significant reduction in mortality attributable to other health conditions (including treatment-related health conditions), analysis controlling for demographic characteristics identified a trend toward reduced risk during more recent eras (P = .007). Disparity by race/ethnicity was identified, with higher mortality among non-Hispanic blacks than among non-Hispanic whites for all-cause and nonrecurrence/nonexternal -cause late mortality. CONCLUSION While overall patterns of mortality from other health conditions do not differ over time, adjustment for demographic characteristics provides evidence that risk of treatment-related mortality may be lower in more recent eras. Disparities in health care utilization among survivors should be explored.
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Affiliation(s)
- Gregory T Armstrong
- MSCE, Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 735, Memphis, TN 38105, USA.
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Sethi P, Jain M. A Comparative Feature Selection Approach for the Prediction of Healthcare Coverage. ACTA ACUST UNITED AC 2010. [DOI: 10.1007/978-3-642-12035-0_41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
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Abstract
This study identified the underlying demographic and socioeconomic factors associated with insurance status among nonelderly Americans (age 19-64), as well as compared health care utilization between insured and uninsured. Data from the Community Tracking Study 1996-1997 Household Survey were analyzed. Approximately 74 percent of uninsured Americans are nonelderly Americans. Among the nonelderly Americans, about 17 percent are uninsured. Our findings show that insurance status varies significantly by region, age, race, gender, marital status, income, education, employment status, and health status. Also, the insured nonelderly Americans were found to have better access to health care than the uninsured nonelderly.
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Abstract
BACKGROUND Many reports have focused attention on the rising percentage of adults in the United States without health insurance. This hides the fact that the uninsured rate for non-Hispanic nonelderly adults has held fairly steady since 1983, while the rate for Hispanics has increased. OBJECTIVES To document the trends in the coverage rate by source of coverage for different population groups between 1983 and 2003 and suggest how changes in the composition of these groups have contributed to these trends. RESEARCH DESIGN We stack panels of the Survey of Income and Program Participation to create a nationally representative 20-year pooled cross-section of nonelderly adults. We calculate actual trends in insurance coverage as well as 2 hypothetical time series that disentangle the effect of the decreasing coverage rate for Hispanics from the growth of the Hispanic adult population. RESULTS Although the increase in uninsured rate is largest for Hispanic noncitizens, US-born Hispanics also have a significant upward trend, primarily driven by a decrease in private coverage, with little change in public coverage. Although the increase in the Hispanic population contributed to the increase in the number of uninsured adults, the widening coverage disparity was more important. CONCLUSIONS Hispanic nonelderly adults, both US-born and immigrants, have fallen behind non-Hispanic nonelderly adults in insurance coverage. Although combinations of economic growth and private and public insurance policy changes have maintained, and in some cases improved, overall coverage rates for non-Hispanics, these changes have not helped Hispanic adults, leading to increased disparities in coverage.
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Increased racial differences on breast cancer care and survival in America: historical evidence consistent with a health insurance hypothesis, 1975-2001. Breast Cancer Res Treat 2008; 113:595-600. [PMID: 18330694 DOI: 10.1007/s10549-008-9960-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 02/27/2008] [Indexed: 10/22/2022]
Abstract
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.
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Abstract
According to published scholarship on health services usage, an increasing number of Americans do not have health insurance coverage. The strong relationship between insurance coverage and health services utilization highlights the importance of reaching out to the uninsured via prevention campaigns and communication messages. This article examines the communication choices of the uninsured, documenting that the uninsured are more likely to consume entertainment-based television and are less likely to read, watch, and listen to information-based media. It further documents the positive relationship between interpersonal communication, community participation, and health insurance coverage. The entertainment-heavy media consumption patterns of the uninsured suggests the relevance of developing health marketing strategies that consider entertainment programming as an avenue for reaching out to this underserved segment of the population.
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Kirk JK, D'Agostino RB, Bell RA, Passmore LV, Bonds DE, Karter AJ, Narayan KMV. Disparities in HbA1c levels between African-American and non-Hispanic white adults with diabetes: a meta-analysis. Diabetes Care 2006; 29:2130-6. [PMID: 16936167 PMCID: PMC3557948 DOI: 10.2337/dc05-1973] [Citation(s) in RCA: 261] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Among individuals with diabetes, a comparison of HbA(1c) (A1C) levels between African Americans and non-Hispanic whites was evaluated. Data sources included PubMed, Web of Science, the Cumulative Index to Nursing and Allied Health, the Cochrane Library, the Combined Health Information Database, and the Education Resources Information Center. RESEARCH DESIGN AND METHODS We executed a search for articles published between 1993 and 2005. Data on sample size, age, sex, A1C, geographical location, and study design were extracted. Cross-sectional data and baseline data from clinical trials and cohort studies for African Americans and non-Hispanic whites with diabetes were included. Diabetic subjects aged <18 years and those with pre-diabetes or gestational diabetes were excluded. We conducted a meta-analysis to estimate the difference in the mean values of A1C for African Americans and non-Hispanic whites. RESULTS A total of 391 studies were reviewed, of which 78 contained A1C data. Eleven had data on A1C for African Americans and non-Hispanic whites and met selection criteria. A meta-analysis revealed the standard effect to be 0.31 (95% CI 0.39-0.25). This standard effect correlates to an A1C difference between groups of approximately 0.65%, indicating a higher A1C across studies for African Americans. Grouping studies by study type (cross-sectional or cohort), method of data collection for A1C (chart review or blood draw), and insurance status (managed care or nonmanaged care) showed similar results. CONCLUSIONS The higher A1C observed in this meta-analysis among African Americans compared with non-Hispanic whites may contribute to disparity in diabetes morbidity and mortality in this population.
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Affiliation(s)
- Julienne K Kirk
- Family and Community Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1084, USA.
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LeMaster JW, Chanetsa F, Kapp JM, Waterman BM. Racial disparities in diabetes-related preventive care: results from the Missouri Behavioral Risk Factor Surveillance System. Prev Chronic Dis 2006; 3:A86. [PMID: 16776887 PMCID: PMC1636706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Racial disparities exist in the rates of diabetes complications in the United States and in the state of Missouri. It is unclear to what degree such disparities involve diabetes-related preventive care. We sought evidence for racial disparities in diabetes-related preventive care between non-Hispanic blacks and whites in Missouri. METHODS We analyzed data from the Missouri Behavioral Risk Factor Surveillance System from 1994 through 2002. This state-specific survey is conducted annually among a representative sample of Missourians. We examined data from 842 Missourians who reported a diagnosis of type 1 or type 2 diabetes and who had consulted a health professional in the 12 months before they were interviewed. We analyzed reported receipt of glycosylated hemoglobin testing, foot examinations, and dilated eye examinations in the year before interview. RESULTS Non-Hispanic blacks were significantly less likely than whites to report having had glycosylated hemoglobin testing (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.22-0.99) but more likely to report having received foot examinations (OR, 1.99; 95% CI, 1.21-2.39). There was no difference between blacks and whites in the probability of dilated eye examinations (OR, 1.49; 95% CI, 0.94-2.36). CONCLUSION Compared with whites, non-Hispanic blacks in Missouri receive adequate screening for diabetic complications but not for glycemic control. Further studies are needed to investigate whether these disparities are linked to differences in the rate of diabetes complications in Missouri.
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Affiliation(s)
- Joseph William LeMaster
- Department of Family and Community Medicine, University of Missouri-Columbia School of Medicine, M241A Health Sciences Bldg DC032.00, Columbia, MO 65212, USA.
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Castellino SM, Casillas J, Hudson MM, Mertens AC, Whitton J, Brooks SL, Zeltzer LK, Ablin A, Castleberry R, Hobbie W, Kaste S, Robison LL, Oeffinger KC. Minority adult survivors of childhood cancer: a comparison of long-term outcomes, health care utilization, and health-related behaviors from the childhood cancer survivor study. J Clin Oncol 2005; 23:6499-507. [PMID: 16170159 DOI: 10.1200/jco.2005.11.098] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the influence of race/ethnicity on outcomes in the Childhood Cancer Survivor Study (CCSS). PATIENTS AND METHODS Of CCSS adult survivors in the United States, 443 (4.9%) were black, 503 (5.6%) were Hispanic and 7,821 (86.6%) were white. Mean age at interview, 26.9 years (range, 18 to 48 years); mean follow-up, 17.2 years (range, 8.7 to 28.4 years). Late mortality, second malignancy (SMN) rates, health care utilization, and health status and behaviors were assessed for blacks and Hispanics and compared with white survivors. RESULTS Late mortality rate (6.5%) and 15-year cumulative incidence of SMN (3.5%) were similar across racial/ethnic groups. Minority survivors were more likely to have lower socioeconomic status (SES); final models were adjusted for income, education, and health insurance. Although overall health status was similar, black survivors were less likely to report adverse mental health (females: odds ratio [OR], 0.6; 95% CI, 0.4 to 0.9; males: OR, 0.5; 95% CI, 0.3 to 0.8). Differences in health care utilization and behaviors noted: Hispanic survivors were more likely to report a cancer center visit (females: OR, 1.5; 95% CI, 1.1 to 2.0; males: OR, 1.7; 95% CI, 1.2 to 2.3); black females were more likely (OR, 1.6; 95% CI, 1.1 to 2.4), and Hispanic females less likely to have a recent Pap smear (OR, 0.7; 95% CI, 0.5 to 1.0); black and Hispanic survivors were less likely to report smoking; black survivors were less likely to report problem drinking. CONCLUSION Adjusted for SES, adverse outcomes in CCSS were not associated with minority status. Importantly, black survivors reported less risky behaviors and better preventive practices. Hispanic survivors had equitable access to cancer related care.
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Affiliation(s)
- Sharon M Castellino
- Department of Pediatrics, East Tennessee State University Quillen College of Medicine, Johnson City, St. Jude Children's Research Hospital, Memphis, TN, USA.
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Smith-Campbell B. Emergency department and community health center visits and costs in an uninsured population. J Nurs Scholarsh 2005; 37:80-6. [PMID: 15813591 DOI: 10.1111/j.1547-5069.2005.00011.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess how a Community Health Center (CHC) influenced access to care for uninsured people and to describe the economic effect on the local hospital. DESIGN A framework on access to health care was used in this community-level, descriptive study. METHODS Data were collected on emergency department (ED) use before state funding of the CHC, 1988 and through 2001. Information included insurance status, charges, diagnosis, and complexity of services received. This study is a population study, and descriptive statistics were used to analyze the data. FINDINGS Within 3 years after state funding of a CHC began, uninsured visits to the local hospital ED decreased by almost 40%. After 10 years, uninsured ED visits remained 25% lower than before state funding began, whereas insured visits had almost doubled (98%). The decrease in number of uninsured visits saved the hospital and uninsured patients almost $14 million. CONCLUSIONS After establishment of the CHC, ED visits by uninsured patients declined. Although a causal link cannot be made between the CHC and ED, the descriptive data provide information about a linkage between the decline of uninsured ED visits and the CHC.
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Aranda JM, Vazquez R. Awareness of hypertension and diabetes in the Hispanic community. ACTA ACUST UNITED AC 2005; 6:7-13; discussion 14-5. [PMID: 15707258 DOI: 10.1016/s1098-3597(04)80060-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Major barriers to awareness and control of hypertension and diabetes in Hispanic Americans include poor language comprehension, poor physician-patient communication, cultural differences, low educational level, and lack of health insurance. To better communicate the concerns about the risk factors for cardiovascular disease, physicians could use patient-education materials that include illustrations, familiarize themselves with their Hispanic patients and their preferences regarding communication (e.g., formality, close proximity, appropriately used touch), and advocate government action to make health insurance more affordable. An increase in Spanish-speaking physicians would help alleviate some of the confusion that Hispanic patients experience in their interactions with health care providers.
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Affiliation(s)
- Juan M Aranda
- University of Florida College of Medicine Gainesville, Shands Heart Transplant Program, Florida 32610, USA
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Nelson DE, Bolen J, Wells HE, Smith SM, Bland S. State trends in uninsurance among individuals aged 18 to 64 years: United States, 1992-2001. Am J Public Health 2004; 94:1992-7. [PMID: 15514242 PMCID: PMC1448574 DOI: 10.2105/ajph.94.11.1992] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2003] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We analyzed state-specific uninsurance trends among US adults aged 18 to 64 years. METHODS We used logistic regression models to examine Behavioral Risk Factor Surveillance System data for uninsurance from 1992 to 2001 in 47 states. RESULTS Overall, uninsurance rates increased in 35 states and remained unchanged in 12 states. Increases were observed among people aged 30 to 49 years (in 34 states) and 50 to 64 years (in 24 states), and increases were also observed among individuals at middle and low income levels (in 39 states and 19 states, respectively), individuals employed for wages (in 33 states), and the self-employed (in 18 states). CONCLUSIONS Among adults aged 18-64, rates of uninsurance increased in most states from 1992 through 2001. Decreased availability of employer-sponsored health insurance, rising health care costs, and state fiscal crises are likely to worsen the growing uninsurance problem.
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Affiliation(s)
- David E Nelson
- Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop K-50, Atlanta, GA 30341, USA.
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Finch BK. Early origins of the gradient: the relationship between socioeconomic status and infant mortality in the United States. Demography 2004; 40:675-99. [PMID: 14686137 DOI: 10.1353/dem.2003.0033] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although relationships between social conditions and health have been documented for centuries, the past few decades have witnessed the emergence of socioeconomic gradients in health and mortality in most developed countries. These gradients indicate that health improves, although decreasingly so, at higher levels of socioeconomic status. To minimize problems with reverse causality, I tested competing hypotheses for observed socioeconomic gradients for infant mortality outcomes. I found no support for the income-inequality hypothesis and negligible support for the occupational-grade hypothesis. The results indicate that absolute material conditions are the most important determinants of socioeconomic effects on the risk of infant mortality and that while poverty has the most pronounced effect on risk, income is decreasingly salutary across the majority of the mortality gradient.
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Affiliation(s)
- Brian Karl Finch
- RAND Corporation, 1700 Main Street, Santa Monica, CA 90407, USA.
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Abstract
OBJECTIVE Although one third of young adults in the United States are uninsured, lack of insurance in this age group has been the subject of few published studies. Because opportunities to obtain public and private insurance are likely to differ for men and women, the objective of this study was to describe the gender-specific relationship of sociodemographic variables and lack of insurance among young adults. METHODS We examined data for 6884 young adults (aged 19-24 years) who completed the Sample Adult Questionnaire of the National Health Interview Survey for 1998, 1999, and 2000. Gender-stratified multiple logistic regression was used to estimate the odds of being uninsured associated with race/ethnicity, household income, major activity in the previous week, marital status, and pregnancy (women). RESULTS Overall, 32% of male participants and 27% of female participants reported being uninsured at the time of the survey. Uninsured men outnumbered insured men in several sociodemographic categories, including Hispanic men (58% uninsured), men not attending high school (85%), and men employed in a workplace that did not offer health insurance (51%). High rates of uninsurance were reported by women not attending high school (65%), Hispanic women (46%), those who were keeping house (41%), and women with a household income between 10 000 dollars and 20 000 dollars (41%). In multiple logistic regression models, many of the sociodemographic variables studied were similarly correlated with health insurance for both men and women. Employment in a workplace where the young adult was not offered health insurance coverage, low household income, low educational attainment, and Hispanic ethnicity were associated with increased odds of being uninsured for both genders. Having attended college, higher household income, and being a student or employed in a workplace that offers health insurance coverage were associated with lower odds of being uninsured for both genders. CONCLUSION This study suggests that additional opportunities for health insurance coverage are needed for young adults-particularly men, Hispanics, and those in low- and middle-income households. Increasing the availability of employment-based health insurance, discouraging attrition from primary and secondary education, and the creation of insurance opportunities for minorities and near-poor and middle-income households are potentially important target areas for programs that seek to reduce the number of uninsured young adults.
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Affiliation(s)
- S Todd Callahan
- Division of Adolescent Medicine and Behavioral Science, Vanderbilt University Medical Center, Nashville, Tennessee 37212-3100, USA.
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Mamo L, Mueller MR. Confronting inequities in HIV/AIDS care in the USA: suggested lines of investigation. CRITICAL PUBLIC HEALTH 2003. [DOI: 10.1080/09581590310001630423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wu LT, Kouzis AC, Schlenger WE. Substance use, dependence, and service utilization among the US uninsured nonelderly population. Am J Public Health 2003; 93:2079-85. [PMID: 14652338 PMCID: PMC1283119 DOI: 10.2105/ajph.93.12.2079] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2002] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the prevalence and correlates of substance use, dependence, and service utilization among uninsured persons aged 12 to 64 years. METHODS We drew study data from the 1998 National Household Survey on Drug Abuse. RESULTS An estimated 80% of uninsured nonelderly persons reported being uninsured for more than 6 months in the prior year. Only 9% of these uninsured persons who were dependent on alcohol or drugs had received any substance abuse service in the past year. Non-Hispanic Whites were an estimated 3 times more likely than Blacks to receive substance abuse services. CONCLUSIONS Compared with the privately insured, uninsured persons had increased odds of having alcohol/drug dependence and appeared to face substantial barriers to health services for substance use problems.
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Affiliation(s)
- Li-Tzy Wu
- RTI International, Research Triangle Park, NC 12194, USA.
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Swan JH, Goldsteen RL, Goldsteen K, Clemeña W. Prospects for single payer coverage after Harry and Louise. JOURNAL OF HEALTH & SOCIAL POLICY 2003; 16:53-73. [PMID: 12877248 DOI: 10.1300/j045v16n03_05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE OF THE STUDY This paper considers evidence of indirect influences of the Harry and Louise media campaign on public support of single payer health coverage in a conservative state. DESIGN AND METHODS Data from a statewide, representative public opinion survey on health reform conducted in Oklahoma over a two-year period, 1992-1994, were combined with data on the Harry and Louise media campaign broadcasts. A two-stage structural-equation model tested the hypothesis that support for single payer varied inversely with support for "mainstream" health reform. RESULTS Findings support the hypothesis, providing evidence that a campaign affecting support for mainstream health reform inversely affects support for single payer, despite the tendency for support for health reform to correlate with support for single payer. IMPLICATIONS Findings suggest that an unintended indirect effect of a campaign against mainstream health reform may have been increased support for single payer. Those proposing future reforms should be aware of available media technologies and how they will be used.
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Affiliation(s)
- James H Swan
- Department of Public Health Sciences, Wichita State University, KS 67260-0152, USA.
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Lorenz KA, Rosenfeld KE, Asch SM, Ettner SL. Charity for the Dying: Who Receives Unreimbursed Hospice Care? J Palliat Med 2003; 6:585-91. [PMID: 14516500 DOI: 10.1089/109662103768253696] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Many deaths occur among persons without insurance coverage for hospice care. We examined the patient and agency characteristics associated with receiving unreimbursed hospice care in a national survey. RESULTS We examined the receipt of unreimbursed care using the 1998 National Home and Hospice Care Survey (NHHCS) discharge dataset. Overall, only 3% of hospice patients received unreimbursed care. Because 98% of older adults are eligible for Medicare, we stratified multivariate analysis on age greater or less than 65 years. Among persons less than 65 years of age, younger, nonwhite persons were more likely to receive unreimbursed care, as were persons with cancer. Agencies providing unreimbursed care to persons over the age of 65 years were more likely to be not-for-profit and freestanding. CONCLUSION Recipients of unreimbursed hospice care are demographically similar to the uninsured, and whether uninsured persons receive unreimbursed hospice care depends on clinical and agency organizational factors related to the motivation to provide unreimbursed care.
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Affiliation(s)
- Karl A Lorenz
- VA Greater Los Angeles Healthcare System, Veterans Integrated Palliative Program, Division of General Internal Medicine, 11301 Wilshire Boulevard, Code 111-G, Los Angeles, CA 90073, USA.
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DeVoe JE, Fryer GE, Phillips R, Green L. Receipt of preventive care among adults: insurance status and usual source of care. Am J Public Health 2003; 93:786-91. [PMID: 12721145 PMCID: PMC1447840 DOI: 10.2105/ajph.93.5.786] [Citation(s) in RCA: 273] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2002] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study ascertained the separate and combined effects of having insurance and a usual source of care on receiving preventive services. METHODS Descriptive and multivariate analyses of 1996 Medical Expenditure Panel Survey data were conducted. RESULTS Receipt of preventive services was strongly associated with insurance and a usual source of care. Significant differences were found between insured adults with a usual source of care, who were most likely to have received services, compared with uninsured adults without regular care, who were least likely to have received services. Those with either a usual source of care or insurance had intermediate levels of preventive services. CONCLUSIONS Having a usual source of care and health insurance are both important to achieving national prevention goals.
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Affiliation(s)
- Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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Guendelman S, Wyn R, Tsai YW. Children of working poor families in California: the effects of insurance status on access and utilization of primary health care. JOURNAL OF HEALTH & SOCIAL POLICY 2003; 14:1-20. [PMID: 12206461 DOI: 10.1300/j045v14n04_01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We examined the effects of health insurance on access and utilization of health care among children of working poor families. These children experience strong access barriers yet have not been studied systematically. 1,492 children in California under 19 years old who had workforce participating parents and a subset of full-time year round working families earning below 200% of poverty were examined from the 1994 National Health Interview Survey. Thirty-two percent of children of working poor families were uninsured in California compared with 26% nationwide. Difficulties in accessing a regular care source and obtaining after-hour care were markedly higher in California. Full-time year round work did not increase insurance coverage and worsened access to a regular source of care. Uninsured children in California were far more likely than insured children to face access barriers and less likely to see a physician in the previous year. Between privately and publicly insured children, the gap in access and utilization narrowed markedly. Health insurance is critical for children in working poor families. Healthy Families, California's response to CHIP, could improve coverage for this population.
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Affiliation(s)
- Sylvia Guendelman
- Division of Health Policy and Management, School of Public Health, University of California, Berkerley 94720-7360, USA.
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Bonds DE, Zaccaro DJ, Karter AJ, Selby JV, Saad M, Goff DC. Ethnic and racial differences in diabetes care: The Insulin Resistance Atherosclerosis Study. Diabetes Care 2003; 26:1040-6. [PMID: 12663570 DOI: 10.2337/diacare.26.4.1040] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes and its complications disproportionately affect African Americans and Hispanics. Complications could be prevented with appropriate medical care. We compared five processes of care and three outcomes of care among African Americans, Hispanics, and non-Hispanic whites. RESEARCH DESIGN AND METHODS We used data from the Insulin Resistance Atherosclerosis Study (1993-1998) of participants with known diabetes. African Americans and Hispanics were compared with non-Hispanic whites from the same region. Five process measures (treatment of diabetes, hypertension, hyperlipidemia, albuminuria, and coronary artery disease) and three outcome measures (control of diabetes, hypertension, and hyperlipidemia) were evaluated. RESULTS Comparison groups were similar in baseline characteristics. African Americans and Hispanics were equally likely as their non-Hispanic white comparison group to receive treatment for diabetes, hypertension, hyperlipidemia, albuminuria, and coronary artery disease, although treatment rates for hyperlipidemia and albuminuria were poor for all groups. African Americans were more likely to have poorly controlled diabetes (HbA(1c) >8.0%: OR 2.23, 95% CI 1.26-3.94). Both African American and Hispanics were significantly more likely to have borderline or poorly controlled hypertension than non-Hispanic whites (blood pressure >130-140/85-90 or >140/90 mmHg: African American/non-Hispanic white OR 3.22, 95% CI 1.57-6.59; Hispanic/non-Hispanic white 3.14, 1.35-7.3). CONCLUSIONS The rates of treatment for diabetes and associated comorbidities are similar across all three ethnic groups. Few individuals in any ethnic group received treatment for hyperlipidemia and albuminuria. Ethnic disparities exist in control of diabetes and hypertension. Programs should be tested to improve overall quality of care and eliminate these disparities.
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Affiliation(s)
- Denise E Bonds
- Section on General Internal Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
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Schafermeyer RW, Asplin BR. Hospital and emergency department crowding in the United States. EMERGENCY MEDICINE (FREMANTLE, W.A.) 2003; 15:22-7. [PMID: 12656782 DOI: 10.1046/j.1442-2026.2003.00403.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Every emergency physician in the United States and, for that matter, in many countries around the world recognizes that the demand for timely access to quality emergency care is one that patients highly value. Unfortunately, hospitals in the USA have become stretched beyond capacity, resulting in overloaded emergency departments, diverted ambulances, and greater risks for patients and providers. Some of the causes and consequences of emergency department crowding are unique to the USA health care system, while others are common to countries throughout the world. The goals for this paper are to provide a brief overview of hospital and emergency department crowding in the USA, to identify commonly cited causes of the problem, and to outline future directions in the search for solutions. A large number of hospitals, inpatient beds, and emergency departments have closed during the past 10 years in the USA. In 1992 there were around 6000 hospitals with emergency departments and there are now less than 4000. While hospitals scrambled to decrease an excess supply of inpatient beds, the demand for emergency department care steadily rose. Between 1992 and 2000, the annual number of emergency department visits in the USA increased from 89.8 to 108 million. While some areas of the USA have been affected more seriously than others (particularly the coasts), almost every state has reported problems with boarding of inpatients in the emergency department. Inpatient boarding is the most frequently cited reason for emergency department crowding within the emergency medicine community. United States hospitals are also struggling with a shortage of health care professionals, particularly registered nurses. There are several policy issues that must be addressed to alleviate hospital and emergency department crowding over the long term. We list these as 'long-term' goals simply because policy changes, in the USA, are often incremental and rarely occur quickly. In order to achieve any of these changes in policy over the long term, advocates for reform must aggressively pursue them today.
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Affiliation(s)
- Robert W Schafermeyer
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA.
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Abstract
OBJECTIVE The relationship between health care insurance and quality of medical care remains incompletely studied. We sought to determine whether type of patient insurance is related to quality of care and subsequent outcomes for patients who arrive in the emergency department (ED) for acute asthma. DESIGN Using prospectively collected data from the Multicenter Airway Research Collaboration, we compared measures of quality of pre-ED care, acute severity, and short-term outcomes across 4 insurance categories: managed care, indemnity, Medicaid, and uninsured. SETTING AND PARTICIPANTS Emergency departments at 57 academic medical centers enrolled 1,019 adults with acute asthma. RESULTS Patients with managed care ranked first and uninsured patients ranked last on all 7 unadjusted quality measures. After controlling for covariates, uninsured patients had significantly lower quality of care than indemnity patients for 5 of 7 measures and had lower initial peak expiratory flow rates than indemnity insured patients. Patients with managed care insurance were more likely than indemnity-insured patients to identify a primary care physician and report using inhaled steroids in the month prior to arrival in the ED. Patients with Medicaid insurance were more likely than indemnity-insured patients to use the ED as their usual source of care for problems with asthma. We found no differences in patient outcomes among the insurance categories we studied. CONCLUSIONS Uninsured patients had consistently poorer quality of care and than insured patients. Despite differences in indicators of quality of care between types of insurance, we found no differences in short-term patient outcomes by type of insurance.
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Affiliation(s)
- Timothy G Ferris
- Institute for Health Policy, Division of General Medicine, Massachusetts General Hospital, Partners HealthCare System and Harvard Medical School, Boston, Mass. 02114, USA.
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Estes CL, Phillipson C. The globalization of capital, the welfare state, and old age policy. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2002; 32:279-97. [PMID: 12067032 DOI: 10.2190/5ty7-pd68-qld1-v4ty] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A new political economy is shaping the lives of present and future generations of older people. The key change has been the move from the mass institutions that defined growing old in the period from 1945 through the late 1970s to the more individualized structures--privatized pensions, privatized health and social care--that increasingly inform the current period. The authors examine the role of international governmental organizations in promoting this trend, with examples drawn from the work of the World Bank, World Trade Organization, and Organization for Economic Cooperation and Development, and the relationship between international governmental organizations and the state. The article concludes with an assessment of the changes to citizenship that accompany globalization and the implications for political organization among older people themselves.
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Finch BK, Frank R, Hummer RA. Racial/ethnic disparities in infant mortality: the role of behavioral factors. SOCIAL BIOLOGY 2002; 47:244-63. [PMID: 12055697 DOI: 10.1080/19485565.2000.9989021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Using the National Maternal and Infant Health Survey 1988 (NMIHS), a nationally representative sample of mothers, we investigate the role of behavioral factors in explaining racial/ethnic disparities in infant mortality. In particular, we focus on the following variables: weight gain during pregnancy, prenatal care utilization, exercise, vitamin use, and substance use during pregnancy. These analyses are conducted by modeling both time of death (neonatal vs. postneonatal) and cause of death (infections, perinatal complications, delivery complications, congenital malformations, SIDS, other causes) outcomes. Our results suggest that behavioral factors are partially responsible for observed race/ethnic differentials in infant mortality, but are not as important as sociostructural determinants such as SES.
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Affiliation(s)
- B K Finch
- Department of Sociology, Florida State University and School of Public Health, University of California, Berkeley, USA.
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Case BGS, Himmelstein DU, Woolhandler S. No care for the caregivers: declining health insurance coverage for health care personnel and their children, 1988-1998. Am J Public Health 2002; 92:404-8. [PMID: 11867320 PMCID: PMC1447089 DOI: 10.2105/ajph.92.3.404] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study examined trends in health insurance coverage for health care workers and their children between 1988 and 1998. METHODS We analyzed data from the annual March supplements of the Current Population Survey (CPS), a Census Bureau survey that collects information about health insurance from a nationally representative sample of noninstitutionalized US residents. RESULTS Of the health care personnel younger than 65 years, 1.36 million (90% confidence interval [CI] = 1.28 million, 1.45 million) were uninsured in 1998, up 83.4% from 1988; the proportion uninsured rose from 8.4% (90% CI = 7.8%, 9.1%) to 12.2% (90% CI = 11.5%, 12.9%). Declining coverage rates in the growing private-sector health care workforce---and declining health employment in the public sector, which provided health insurance benefits to more of its workers---accounted for the increases. Households with a health care worker included 1.12 million (90% CI = 1.05 million, 1.20 million) uninsured children, accounting for 10.1% (90% CI = 9.5%, 10.8%) of all uninsured children in the United States. CONCLUSIONS Health care personnel are losing health insurance coverage more rapidly than are other workers. Increasingly, the health care sector is consigning its own workers and their children to the ranks of the uninsured.
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Affiliation(s)
- Brady G S Case
- Harvard Medical School, 955 Massachusetts Ave., PMB #321, Cambridge, MA 02139, USA.
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Ferris TG, Crain EF, Oken E, Wang L, Clark S, Camargo CA. Insurance and quality of care for children with acute asthma. AMBULATORY PEDIATRICS : THE OFFICIAL JOURNAL OF THE AMBULATORY PEDIATRIC ASSOCIATION 2001; 1:267-74. [PMID: 11888414 DOI: 10.1367/1539-4409(2001)001<0267:iaqocf>2.0.co;2] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Increasing attention has been paid to the role of insurance in determining quality and outcomes of care. Pressures to reduce health costs and to improve quality have prompted attempts by managed care organizations to decrease the use of the emergency department (ED) for acute asthma, but performance comparisons between insurance types remain rare. METHODS We used prospective data from the Multicenter Airway Research Collaboration on 965 children with acute asthma presenting to 36 EDs. We compared measures of quality of pre-ED care, acute severity, and short-term outcomes (length of stay, percent relapse, and percent with ongoing symptoms) across 4 different insurance categories: managed care, indemnity, Medicaid, and uninsured. We used multivariate regression to control for differences in education, estimated income, race/ethnicity, and chronic asthma severity and acute asthma characteristics. RESULTS Children with managed care and indemnity had similar demographic and asthma characteristics, but these children differed significantly from Medicaid and uninsured patients. Managed care and indemnity insured children had similar ratings on all 7 quality measures, with Medicaid and uninsured children ranking significantly lower on most measures, including (1) percent with primary care provider (PCP) (P <.001), (2) percent using ED as usual site of asthma care (P <.001), (3) percent using ED for prescriptions (P <.001), (4) percent with a ratio of >1 of ED visits to acute office visits within the past year (P =.003), and (5) percent visiting their PCP within the week prior to ED visit (P <.001). Children with managed care were more acutely ill than were indemnity, Medicaid, or uninsured children on presentation to the ED (pulmonary index of 4.6, 4.0, 4.2, and 3.9, respectively, P =.007). There were no significant differences in length of hospital stay, relapse, and ongoing exacerbation. CONCLUSIONS Our results indicate similar quality of care, greater severity of acute asthma, and no worse outcomes for children with managed care compared to children with indemnity insurance. We found uninsured children to have consistently poorer quality of care than insured patients.
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Affiliation(s)
- T G Ferris
- Institute for Health Policy, Massachusetts General Hospital, Boston, USA
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Affiliation(s)
- D L Washington
- Veterans Affairs Greater Los Angeles Healthcare System Department of medicine 11301 Wilshire Blvd, 111G Los Angeles, CA 90073, USA.
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Patel K. Down and out in America: children and health care. JOURNAL OF HEALTH & SOCIAL POLICY 2001; 13:33-56. [PMID: 11263099 DOI: 10.1300/j045v13n04_03] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
One of the worst forms of inequality in the health care field is the inequality suffered by children. In 1996, over 14.5 million children lived in poverty in the United States. Children who live in poverty are less likely to have health insurance and have less access to health care and thus are more likely to suffer negative outcomes in health care. The Congress of the United States in 1997 enacted the State Children's Health Insurance Program (S-CHIP) to expand health insurance coverage for children. This paper examines the major features of the program, actions undertaken by the state governments under this program to expand health insurance coverage for children, and provides some preliminary analysis of the potential positive and negative impact of the program.
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Affiliation(s)
- K Patel
- Department of Political Science, Southwest Missouri State University, 901 S. National, Springfield, MO 65804, USA.
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Asplin BR, Knopp RK. A room with a view: on-call specialist panels and other health policy challenges in the emergency department. Ann Emerg Med 2001; 37:500-3. [PMID: 11326186 DOI: 10.1067/mem.2001.115174] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Sherbourne CD, Dwight-Johnson M, Klap R. Psychological distress, unmet need, and barriers to mental health care for women. Womens Health Issues 2001; 11:231-43. [PMID: 11336863 DOI: 10.1016/s1049-3867(01)00086-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Using data from the Commonwealth Fund 1998 Survey of Women's Health, this article describes the characteristics of women in need of mental health services for depression or anxiety, and identifies factors related to why women do not get needed care. Depressive/anxiety symptoms are common and access to care for psychological distress remains a problem for many women, especially for minorities, those with less education, and those without a usual source of health care. Sources of unmet need include patient factors, clinician factors, and characteristics of the health system, such as costs of mental health care.
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Benkert R, Buchholz S, Poole M. Hypertension outcomes in an urban nurse-managed center. JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS 2001; 13:84-9. [PMID: 11930402 DOI: 10.1111/j.1745-7599.2001.tb00223.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the quality of hypertension (HTN) care in an urban nurse-managed center (NMC) by chart audits of insured and uninsured (N = 52) African Americans who were managed by nurse practitioners. DATA SOURCES A chart audit form was developed by the authors that merged Health Plan Employer Data and Information Set (HEDIS) criteria with the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) criteria. CONCLUSIONS There was near comparable hypertension control among the two groups. No difference was found in systolic blood pressure (BP) control; however, the uninsured group had a slightly greater average diastolic BP compared with the insured group. There was no significant difference in the number of HTN medications or the number of risk factors. A significant difference was found in the number of NP visits per year between the two groups; the uninsured group averaged 3.2 more visits per year. IMPLICATIONS FOR PRACTICE Nurse practitioners in this NMC were able to manage HTN in a high-risk population despite a lack of insurance coverage for anti-hypertensive prescriptions. The finding that the uninsured group had more clinic visits per year than the insured group is significant in that it increases the cost of providing care for these patients and the health care system. The patient cost in time, transportation and burden needs further assessment.
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Affiliation(s)
- R Benkert
- Wayne State University, College of Nursing, Detroit, MI, USA.
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Vogel WB. How resource allocation decisions are made in the health care market. Pharmacotherapy 2000; 20:333S-339S. [PMID: 11034062 DOI: 10.1592/phco.20.16.333s.35011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This paper describes how economists view resource allocation decisions in health care markets. The basic economic decisions that must be made in any economic system and the resource allocation decisions in a perfectly competitive market are described. An idealized market can achieve an efficient allocation of resources and is contrasted with a more realistic description of the numerous ways in which health care markets depart from the perfectly competitive ideal. The implications of these departures for health care policy are discussed, along with key controversies concerning reliance upon markets for resource allocation in health care. In particular, the failure of competitive markets to achieve what many consider an equitable distribution of health care is emphasized. The paper concludes with some practical observations on how pharmacists can use the increasing emphasis on economic efficiency to the advantage of their profession.
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Affiliation(s)
- W B Vogel
- Department of Health Services Administration and Institute for Health Policy Research, University of Florida, Gainesville 32610, USA
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Cetta MG, Asplin BR, Fields WW, Yeh CS. Emergency medicine and the debate over the uninsured: a report from the task force on health care and the uninsured. Ann Emerg Med 2000; 36:243-6. [PMID: 10969230 DOI: 10.1067/mem.2000.109911] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- M G Cetta
- Washington Hospital Center, Washington, DC, Regions Hospital and the HealthPartners Research, Foundation, St. Paul, MN 55101, USA
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Abstract
The black/white ratio of death rates (before 65 years of age) in 1994-1996 for a group of "sentinel" causes, regarded as preventable by medical treatment and as useful in assessing overall quality of health care, was examined for 60 US counties located in large metropolitan areas. Counties with the highest black/white death rate ratios (>3.5) and the highest death rates for blacks included the District of Columbia; Essex (Newark), New Jersey; Cook (Chicago), Illinois; Wayne (Detroit), Michigan; and Dade (Miami), Florida. In these five counties, in contrast to the US, the death rate from the sentinel causes for blacks had not declined from 1979-1981 to 1994-1996. The findings suggest that racial inequities in health care may be unusually great in certain counties in large metropolitan areas, and that further studies are needed to explain the variation among counties in the black-white ratio of mortality from the sentinel causes.
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Affiliation(s)
- A P Polednak
- Connecticut Department of Public Health, Hartford 06134, USA
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Abstract
The purpose of this paper is to stimulate debate on the implications of the new genetics for health policy. Although there are different streams within the social science literature on the new genetics, the primary focus has been on the meaning of genetic testing from the perspective of the individual tested. While essential to understand, it does not add much to the health policy debate. A very different type of information has been produced by the public health and epidemiological literature, focused on screening for genetic disease and concerned with rates of detection, costs and benefits, and evaluation criteria. These data are very important to planning and implementing the type of prenatal screening program already in existence; they do not deal with issues central to the new genetics, such as commercialization, patenting and insurance. The problem is how best these topics should be researched. The final section of the paper suggests that given a phenomenon--the new genetics--which is both multifaceted and very complex, very new and yet with strong historical and cultural roots, we need a matching research agenda. One that breaks out of traditional paradigms separating one method from another and seeks information on the new genetics wherever it may be found.
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Affiliation(s)
- P A Kaufert
- The University of Manitoba, Faculty of Medicine, Department of Community Health Sciences, Winnipeg, Canada.
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Sturm R, Wells K. Health insurance may be improving--but not for individuals with mental illness. Health Serv Res 2000; 35:253-62. [PMID: 10778813 PMCID: PMC1089099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE To explore the question of how insurance coverage has changed among individuals with mental problems compared to the general population in the last two years. DATA SOURCES HealthCare for Communities, a national survey to track health system changes. PRINCIPAL FINDINGS The percentage of uninsured persons in the general population has not changed very much, and more respondents believe that health insurance coverage has improved rather than deteriorated over the years 1996 to 1998. However, among individuals with probable mental health disorders, more have lost insurance in those two years than have gained it and more report decreases in health benefits. Individuals with worse mental health consistently report a deterioration of access to care compared to individuals with better mental health. CONCLUSIONS Substantial activity has taken place in state and federal legislation to increase the mental health benefits offered by health insurance. Although this activity could have improved health insurance especially for individuals with mental illness, such persons continue to fare significantly worse than the general population.
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Affiliation(s)
- R Sturm
- RAND, Santa Monica, CA 90401, USA
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Carrasquillo O, Himmelstein DU, Woolhandler S, Bor DH. Trends in health insurance coverage, 1989-1997. INTERNATIONAL JOURNAL OF HEALTH SERVICES 1999; 29:467-83. [PMID: 10450542 DOI: 10.2190/1av3-e901-tn3d-3h38] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The authors analyze trends in health insurance coverage in the United States from 1989 through 1997, using cross-sectional surveys by the U.S. Census Bureau (Current Population Survey) of 160,000 persons representative of the non-institutionalized population. Between 1989 and 1997, the number of people without health insurance increased by 10.1 million to 43.4 million. From 1989 to 1993, the proportion covered by Medicaid increased by 3.6 percentage points while the proportion covered by private insurance declined by 4.2 percentage points. Since then, private coverage rates have stabilized and Medicaid coverage has decreased. Consequently, the number and percent uninsured continues to rise. Young adults age 18-39 had the largest increase in the proportion uninsured, and rates among children have also risen steeply since 1992. While blacks had the largest increase in the percent uninsured, Hispanics accounted for 35.6 percent of the increase in the number uninsured. Low-income families constituted over half of the increase in the number uninsured, but since 1993 the middle income group had the largest increase in the percent uninsured. Northeastern states had the largest increase in the percent uninsured. Thus, despite economic prosperity, the numbers and rates of the uninsured continue to rise. Principally affected are children and young adults, poor and middle-income families, blacks, and Hispanics.
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Affiliation(s)
- O Carrasquillo
- Division of General Internal Medicine, Columbia Presbyterian Medical Center, New York, NY 10032, USA
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Mainous AG, Hueston WJ, Love MM, Griffith CH. Access to care for the uninsured: is access to a physician enough? Am J Public Health 1999; 89:910-2. [PMID: 10358685 PMCID: PMC1508656 DOI: 10.2105/ajph.89.6.910] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study examined a private-sector, statewide program (Kentucky Physicians Care) of care for uninsured indigent persons regarding provision of preventive services. METHODS A survey was conducted of a stratified random sample of 2509 Kentucky adults (811 with private insurance, 849 Medicaid recipients, 849 Kentucky Physicians Care recipients). RESULTS The Kentucky Physicians Care group had significantly lower rates of receipt of preventive services. Of the individuals in this group, 52% cited cost as the primary reason for not receiving mammography, and 38% had not filled prescribed medicines in the previous year. CONCLUSIONS Providing free access to physicians fills important needs but is not sufficient for many uninsured patients to receive necessary preventive services.
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Affiliation(s)
- A G Mainous
- Department of Family Medicine, Medical University of South Carolina, Charleston 29425, USA.
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