Browsing by Subject "Medically Uninsured"

Now showing 1 - 5 of 5
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    Access to Reconstructive Hand Surgery in the United States-Investigating the Obstacles: A Scoping Review.
    (Hand (New York, N.Y.), 2023-07) Kohan, Joshua; Mangan, Jack; Patel, Ashit

    Background

    Mechanisms that affect access to surgical hand care appear to be complex and multifaceted. This scoping review aims to investigate the available literature describing such mechanisms and provide direction for future investigation.

    Methods

    The methodological framework outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews was used to guide this review. In November 2021, MEDLINE and EMBASE databases were searched. A narrative summary of the characteristics and key findings of each paper is used to present the data to facilitate the integration of diverse evidence.

    Results

    Of 471 initial studies, 49 were included in our final analysis. Of these, 33% were cohort studies; 27% reported that underinsured patients are less likely to get an appointment with a hand specialist or to receive treatment. Overburdened emergency departments accounted for the second-most reported reason (16%) for diminished access to surgical hand care. Elective procedure financial incentives, poor emergency surgical hand coverage, distance to treatment, race, and policy were also notably reported across the literature.

    Conclusions

    This study describes the vast mechanisms that hinder access to surgical hand care and highlights their complexity. Possible solutions and policy changes that may help improve access have been described.
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    Experiences of COVID-19 infection in North Carolina: A qualitative analysis.
    (PloS one, 2022-01) Seidenfeld, Justine; Tupetz, Anna; Fiorino, Cassandra; Limkakeng, Alexander; Silva, Lincoln; Staton, Catherine; Vissoci, Joao RN; Purakal, John

    Background and aim

    It has been demonstrated that marginalized populations across the U.S. have suffered a disproportionate burden of the coronavirus disease 2019 (COVID-19) pandemic, illustrating the role that social determinants of health play in health outcomes. To better understand how these vulnerable and high-risk populations have experienced the pandemic, we conducted a qualitative study to better understand their experiences from diagnosis through recovery.

    Methods

    We conducted a qualitative study of patients in a North Carolina healthcare system's registry who tested positive for COVID-19 from March 2020 through February 2021, identified from population-dense outbreaks of COVID-19 (hotspots). We conducted semi-structured phone interviews in English or Spanish, based on patient preference, with trained bilingual study personnel. Each interview was evaluated using a combination of deductive and inductive content analysis to determine prevalent themes related to COVID-19 knowledge, diagnosis, disease experience, and long-term impacts.

    Findings

    The 10 patients interviewed from our COVID-19 hotspot clusters were of equal distribution by sex, predominantly Black (70%), aged 22-70 years (IQR 45-62 years), and more frequently publicly insured (50% Medicaid/Medicare, vs 30% uninsured, vs 20% private insurance). Major themes identified included prior knowledge of COVID-19 and patient perceptions of their personal risk, the testing process in numerous settings, the process of quarantining at home after a positive diagnosis, the experience of receiving medical care during their illness, and difficulties with long-term recovery.

    Discussion

    Our findings suggest areas for targeted interventions to reduce COVID-19 transmission in these high-risk communities, as well as improve the patient experience throughout the COVID-19 illness course.
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    Private health insurance coverage for substance abuse and mental health services, 1995 to 1998.
    (Psychiatric services (Washington, D.C.), 2004-02) Wu, Li-Tzy; Schlenger, William E
    Four years of data from the National Household Survey on Drug Abuse were combined to examine the characteristics of underinsurance in a sample of privately insured Americans aged 18 to 64. Among these adults, 38 percent (45 million) reported not having behavioral health coverage or not knowing their coverage. Young adults aged 18 to 25, Hispanics, Asians, adults in the lowest income level, and less educated adults were more likely to be underinsured. Untreated addictive and psychiatric problems are costly to society. Underinsurance among socially disadvantaged subgroups deserves greater attention from researchers and policy makers.
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    Substance use, dependence, and service utilization among the US uninsured nonelderly population.
    (American journal of public health, 2003-12) Wu, Li-Tzy; Kouzis, Anthony C; Schlenger, William E
    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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    Use of substance abuse services by young uninsured american adults.
    (Psychiatric services (Washington, D.C.), 2005-08) Wu, Li-Tzy; Ringwalt, Chris
    OBJECTIVES:This study examined the prevalence and correlates of substance abuse service use among uninsured young adults aged 18 to 34 years (N=24,282). METHODS:Data were drawn from the 1999 National Household Survey on Drug Abuse. Logistic regression was used to identify correlates of substance abuse service use among persons who met DSM-IV criteria for dependence. RESULTS:Among uninsured young adults (N=5,067), 66 percent lacked any health care coverage for at least one year. In this uninsured group, 72 percent were past-year users of alcohol or drugs (N=2,335). Among past-year alcohol users (N=2,273), 12 percent met criteria for alcohol dependence; among past-year drug users (N=864), 21 percent met dependence criteria. Eighty-seven percent of the uninsured young adults with alcohol or drug dependence did not receive any substance abuse treatment services in the previous year. In the uninsured substance-dependent group, women, blacks, and Hispanics were less likely than men and whites to use substance abuse services. Among those with substance dependence, uninsured persons were more likely than privately insured persons to receive substance abuse services from the self-help or human service (nonmedical) sector. CONCLUSIONS:Racial, ethnic, and gender disparities in the use of substance abuse services are notable among young adults who lack health insurance.