Browsing by Subject "Health insurance"
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Item Open Access Diferencias y disparidades de salud para la comunidad hispana en Durham(2020-04-01) Lovvorn, CarterDue to multiple factors including language and culture, predominantly Hispanic neighborhoods in Durham County may experience health differently than other areas in the county. In conjunction with the Durham County Department of Public Health, culturally and linguistically sensitive health surveys were given to Durham neighborhoods with 50% or more Hispanics to assess if and how they may experience health differently from the rest of the county. Results indicate that people from these neighborhoods are less likely to have a primary care physician and less likely to have health insurance than those from the county at large. Additionally, these communities face large amounts of discrimination and often do not get the emotional support that they need. Lastly, as a result of unsafe neighborhoods and other important factors, obesity and diabetes are a large problem within these communities. In addition to the language barrier and culture, other more structural issues like economic and environmental factors are some of the causes that can lead to adverse health outcomes in these communities. While health education resources do exist within the county, they are not commonly known and could be made more readily available.Item Open Access Ensuring Healthy Children: The Effect of Health Insurance on Primary Health Care for Children(2010-12-10) Sanderson, AnthonyBackground Past studies have typically focused on the effect of health insurance on primary health care for children, but few have assessed the effect the type of health insurance coverage has on primary care. This research studied the effect of health insurance status—uninsured, private insurance, public coverage, or other insurance—on the accessibility, continuity, and comprehensiveness of primary health care for children. Methods This research analyzed a sample of 39,225 children under 18 years of age from the 2006-2009 National Health Interview Survey, a nationally representative sample of households in the United States. The response rate for children was 75.2 percent. Logistic regression models were used to analyze the effect of health insurance on health status and three aspects of primary care: accessibility (physician visit; usual source of care; time since health professional visit), continuity, (usual source and site of care), and comprehensiveness (physical). Excellent or very good health status was the final dependent variable. Results Compared to children with private health insurance, uninsured children and Medicaid or State Children’s Health Insurance Program (SCHIP) beneficiaries are 27% (p<0.001) and 89.4% (p<0.01) as likely, respectively, to have visited a physician within the last twelve months (LTM). Approximately 73% of uninsured children reported having a usual source of care, compared to 96% of children with private insurance and 98% of Medicaid/SCHIP beneficiaries. Children with private health insurance are at least twice as likely to report “excellent or very good” health as children with any other health insurance status (p<0.001). After controlling for the confounding effects of age, citizenship, mother’s education, father’s education, health status, poverty status, race/ethnicity, and region, Medicaid/SCHIP coverage is associated with similar, if not better, accessibility, continuity, and comprehensiveness of primary care compared to children with private insurance. Conclusions Although by many indicators Medicaid and SCHIP enrollees have worse primary care than children with private health insurance, Medicaid and SCHIP beneficiaries are more likely to have risk factors that are associated with poorer primary care and poorer child health status. Nevertheless, clear relationships cannot be established to conclude how government health insurance programs perform relative to private insurance. Health insurance status is an important predictor, but not the only predictor, of the accessibility, continuity, and comprehensiveness of primary care. Other important risk factors include adolescence, non-U.S. citizenship, low levels of mother’s education, poverty, and residence in the West or South.Item Open Access Financial burden of healthcare for cancer patients with social medical insurance: a multi-centered study in urban China.(Int J Equity Health, 2017-10-10) Mao, Wenhui; Tang, Shenglan; Zhu, Ying; Xie, Zening; Chen, WenBACKGROUND: Cancer accounts for one-fifth of the total deaths in China and brings heavy financial burden to patients and their families. Chinese government has made strong commitment to develop three types of social medical insurance since 1997 and recently, more attempts were invested to provide better financial protection. To analyze health services utilization and financial burden of insured cancer patients, and identify the gaps of financial protection provided by insurance in urban China. METHODS: A random sampling, from Urban Employee's Basic Medical Insurance claim database, was performed in 4 cities in 2008 to obtain insurance claim records of cancer patients. Services utilization, medical expenses and out-of-pocket (OOP) payment were the metrics collected from the insurance claim database, and household non-subsistence expenditure were estimated from Health Statistics. Catastrophic health expenditure was defined as household's total out-of-pocket payments exceed 40% of non-subsistence expenditure. Stratified analysis by age groups was performed on service use, expenditure and OOP payment. RESULTS: Data on 2091 insured cancer patients were collected. Reimbursement rates were over 80% for Shanghai and Beijing while Fuzhou and Chongqing only covered 60%-70% of total medical expenditure. Shanghai had the highest reimbursement rate (88.2%), high total expenditure ($1228) but lowest OOP payment ($170) among the four cities. Chongqing and Fuzhou's insured cancer patients exclusively preferred tertiary hospitals for outpatient services. Fuzhou led the annual total medical expense ($9963), followed by Chongqing, Beijing and Shanghai. The average OOP as proportion of household's capacity to pay was 87.3% (Chongqing), 66.0% (Fuzhou), 33.7% (Beijing) and 19.6% (Shanghai). Elderly insured cancer patients utilized fewer outpatient services, had lower number of inpatient admissions but longer length of stay, and higher total expenditure. CONCLUSIONS: Social economic development was not necessarily associated with total medical expense but determined the level of financial protection. The economic burden of insured cancer patients was reduced by insurance but it is still necessary to provide further financial protections and improve affordability of healthcare for cancer patients in China.Item Open Access Health Care Utilization and Health Status of NCMS Elderly Enrollees in China: Evidence from CHARLS Data(2012-04-16) Li, Amy; Wang, PengpengThis study explores the effect of benefit designs and demographic factors on health care utilization and health status of elderly rural enrollees in the New Cooperative Medical Scheme, a rural health insurance program implemented by the Chinese government in 2003. Using the new data from CHARLS pilot study, we find that immediate reimbursement does not have a statistically significant effect on health utilization as suggested in a previous study, but instead on health status. Other policy-related factors neither have a significant effect due to limited data and large standard deviation nor display a consistent effect.Item Open Access Impact of Medicare Advantage Supplemental Benefit Expansion on Startup Funding(2023-08-05) Zhong, JudyIn 2018, the Center for Medicare and Medicaid Services (CMS) announced that they would expand the supplemental benefits that can be included in Medicare Advantage (MA) plans. The goal was to encourage insurers to innovate and test new benefit offerings that could improve health outcomes and reduce healthcare spending. A key player in this transformation is the MA vendor that provides supplemental benefit offerings to insurance plans, but this market is rather underdeveloped. To assess the implementation of this supplemental benefit expansion, this study examines the flow of funding into the emerging market of MA vendors. This paper uses a longitudinal approach and Crunchbase data on funding for 79,004 firms from 2014 to 2018 to determine whether there is a significant jump in funding toward MA vendors with supplemental benefit services following the policy change. The results show that both the average amount of funding per deal and the number of deals a MA vendor firm receives significantly increased following the expansion when compared with all other firms. This suggests that the policy may have been successful in promoting the development of the MA vendors market and the innovation of benefit offerings as more funding goes towards these companies.Item Open Access Impact of Workplace Health Centers on Health Care Spending and Utilization Among Plant Workers in California’s Central Valley(2020-06) Pothen, MerilEmployers are becoming more active in strategies to reduce health care spending while maintaining or improving health outcomes for employees. Workplace wellness programs (WWPs) are popular, but the research is mixed on their efficacy in reducing spending and unnecessary utilization. Workplace health centers (WHCs), onsite clinics providing primary and additional care, are a viable alternative for self-funded, large employers. This study’s client, a $4.6B privately held agribusiness, opened its WHCs in late 2015 at two of its largest worksites. Analysis of health care-seeking employees with and without access to the WHCs found that access is associated with reductions in total health spending and utilization. The company’s WHCs also disproportionately benefited employees with chronic conditions, causally reducing non-emergent utilization for those with hyperlipidemia and diabetes. Links between WHC access and reduced spending, fewer ER visits, and fewer hospitalizations were also observed for other chronic conditions. By positioning WHCs as a substitute to traditional office visits and urgent care, company leadership can encourage employees to seek care “in house” and therefore have narrower external networks, resulting in cost savings. The chronic conditions population should continue to be the company’s focus in its health and wellness initiatives. Other large, self-funded employers considering WHCs should design their services to replace non-emergent care and cater to employees with chronic conditions.Item Open Access Managing Diabetes in Urban Ghana: Is it Affordable?(2015) Pei, FengdiBackground: In recent decades there has been an escalating epidemic of diabetes in Ghana. However, there has been little research on the economic burdens associated with diabetes in Ghana, despite diabetes's costly nature. This study investigated economic burdens and financial protections of households with diabetes patient(s) in urban Ghana.
Methods: Questionnaire-based interviews were conducted with 40 diabetes patients and their household heads in two urban communities in the city of Accra, Ghana. Information was obtained regarding participants' demographic and socioeconomic characteristics, patterns of healthcare utilization, direct and indirect costs, and financial protections pertaining to diabetes treatment and management. Cost-of-illness analysis and catastrophic health expenditure computation were conducted to investigate the costs associated with diabetes and households' affordability. Statistical tests were also conducted to analyze the effect of the National Health Insurance Scheme (NHIS) on the costs associated with diabetes.
Results: The total cost of diabetes for 40 households was estimated to be 14,989 cedis/month, of which 66.5% was direct cost and 30.2% was indirect cost. 52.9% of the households occurred catastrophic health expenditure. The means of outpatient and inpatient expenditure were 136 and 418 Cedi/month, respectively. NHIS had a positive financial protection effect on the economic burden of diabetes, while this effect was diminished by deficiencies in NHIS. Extended family was the main resource of financial support for diabetes treatment and management.
Conclusion: The economic burden of diabetes is high in urban Ghana, with a catastrophic effect on households. Except for NHIS, patients' financial support mainly comes from personal resources rather than public resources. Social supports and improvements in NHIS are needed to protect households with diabetes patient(s) against financial risks.
Item Open Access The Impact of Medicaid Expansion on Health Care Access, Utilization, and Health(2017-12-06) Yan, Brandon W.Under the Affordable Care Act (ACA), 32 states expanded Medicaid coverage to include adults with household incomes up to 138% of the Federal Poverty Level. Today, Medicaid remains a subject of intense state and federal budgetary and policy debates. To analyze the impact of the ACA’s Medicaid expansion on adults in poverty, I used national data from the 2011-2016 Behavioral Risk Factor Surveillance System to assess trends in health access, preventive service utilization, and health outcomes. I further stratified the analysis to investigate differential impacts on subpopulations including breakdowns by income, race, and age. As measured by rates of uninsurance, inability to afford doctor visits, and lacking a personal doctor, health care access improved significantly more in states that expanded Medicaid than those that did not. Medicaid expansion was associated with a 5.4% decrease in the uninsured rate and a 1.9% increase in the probability of having a routine checkup in the past 12 months. Whites and adults ages 55-64 experienced some of the greatest gains in health care access and routine checkup utilization. Health status improvement approached significance nationally but was significant among those in the $10,000-$14,999 income group. Medicaid expansion was also associated with increases in diagnoses of high blood pressure and high cholesterol. These findings indicate sustained improvements in access to care and evidence of changes in utilization and health that differ by population subgroups. Federal and state policymakers should weigh these benefits in considering Medicaid reforms and Medicaid expansion adoption.