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PubMed1990

Local advocacy for the medically indigent. Strategies and accomplishments in one county.

Access to health care for the medically indigent has emerged as a major policy issue throughout the United States. Because no national health program ensures entitlement to basic services, practitioners and patients must cope with barriers to access on the local level. We report several separate but integrated strategies that a community-based coalition has used to achieve improvements in indigent care within a single county. Research strategies have involved short-term investigations of barriers to needed services so that local awareness of the problem would increase rapidly. Political strategies have attempted to improve the county government's administrative procedures and financial support of services for the poor, to modify the practices of local health care institutions, and to influence state and national policies that affect local conditions. Legal strategies have involved the participation of attorneys who represent clients unable to receive care and who could initiate litigation as appropriate. Each of these strategies contains weaknesses as well as strengths. Although such advocacy efforts do not achieve a coherent system that guarantees access, they can substantially improve the availability of local services.

California↗
PubMed1997

A longitudinal investigation of medical student attitudes toward the medically indigent.

BACKGROUND: Studies have shown that medical student attitudes decline as students progress through school. Controversy persists about the meaning and generalizability of these findings because studies have not been longitudinal and many were conducted prior to an influx of female students. Much of medical education occurs in academic medical center environments where disproportionate numbers of indigent (uninsured and underinsured) patients seek care. This study examined whether students' attitudes toward providing care to indigent clientele changed over time. PURPOSE: To track longitudinal changes in attitudes toward providing care for the medically indigent of 1 cohort of medical students and to determine if gender differences existed and persisted over time. METHODS: Students entering a Southwest medical school in 1989 participated in this study. Attitudes were compared using the Medical Students' Attitudes Toward the Underserved questionnaire, a self-report, attitudinal scale. RESULTS: Student attitudes declined during the 1st year of school, remained fairly stable during Years 2 and 3, and declined further during Year 4. Analyses comparing 1st- and 4th-year students showed a decline in attitudes for men and women for each scale except Basic Services. Although both women's and men's attitudes declined, women's attitudes remained more favorable across the 4 years. CONCLUSIONS: A clearer understanding of how female medical students sustain socially responsible attitudes throughout medical school may help educators develop support mechanisms for men and women that would promote an ethic of social responsibility and encourage students to work with indigent clientele.

Journal Article↗
PubMed1985

An analysis of competitive bidding by providers for indigent medical care contracts.

This article develops a model of behavior in bidding for indigent medical care contracts in which bidders set bid prices to maximize their expected utility, conditional on estimates of variables which affect the payoff associated with winning or losing a contract. The hypotheses generated by this model are tested empirically using data from the first round of bidding in the Arizona indigent health care experiment. The behavior of bidding organizations in Arizona is found to be consistent in most respects with the predictions of the model. Bid prices appear to have been influenced by estimated costs and by expectations concerning the potential loss from not securing a contract, the initial wealth of the bidding organization, and the expected number of competitors in the bidding process.

Arizona↗
PubMed1989

Cost estimate of health care coverage for the medically indigent in Hawaii.

The objective of the study was to estimate the cost of health insurance coverage of the medically indigent in Hawaii. The number of uninsured was estimated deductively from the coverages of those insurance companies doing business in the state, with an additional factor for persons with more than one policy coverage. Age and sex breakdowns of the uninsured were entered into actuarial tables and fee-for-service and HMO plan costs were obtained for the most prevalent health plan in the state. Annual coverage is estimated at US$46.090866 million and US$58.040700 million for fee-for-service and HMO plans, respectively. Seven potential sources of financing and five recommendations for further research are given.

Actuarial Analysis↗
PubMedDate not supplied

Survey search: health executives on care for the medically indigent.

The American College of Healthcare Executives polled 359 members about their attitudes toward access to care for the 37 million Americans considered "medically indigent," and for all citizens, as well as toward the roles of government, physicians and hospitals in funding and providing such care. The findings reveal mixed feelings--and rationalizations about them--reminiscent of those of British National Health Service administrators.

Attitude of Health Personnel↗
PubMed1990

Case twelve. Positioning a small rural hospital to respond to the requirements of a recently enacted state-wide medically indigent assistance act.

The case hospital was required to strategically respond to significant environmental challenges brought into play by the legislative enactment of a new Medically Indigent Assistance Act (MIAA). Publicity surrounding the debate leading up to the passage of the new law by the state legislature placed the hospital under unprecedented scrutiny by local taxpayers, healthcare recipients, elected officials, advocates for the poor and other local providers of healthcare services. This case reports the implementation of a highly desired strategy on the part of the hospital and the necessary roles of multiple stakeholders in the realization of hospital strategy. The case also illustrates the spill-over effects of stakeholder relationships developed in pursuit of particular strategy on the organization's ability to pursue future strategy.

Charities↗
PubMed1992

Local advocacy for the medically indigent: strategies and accomplishments in one county.

Access to health care for the medically indigent has emerged as a major policy issue throughout the United States. Because no national health program assures entitlement to basic services, practitioners and patients must cope with barriers to access on the local level. The authors report several separate but integrated strategies that a community-based coalition has used to achieve improvements in indigent care within a single county. Research strategies have involved short-term investigations of barriers to needed services, so that local awareness of the problem would increase rapidly. Political strategies have attempted to improve the county government's administrative procedures and financial support of services for the poor, to modify the practices of local health care institutions, and to influence statewide and national policies affecting local conditions. Legal strategies have involved the participation of attorneys who represent clients unable to receive care and who could initiate litigation as appropriate. Each of these strategies contains weaknesses as well as strengths. Although such advocacy efforts do not achieve a coherent system guaranteeing access, they can substantially improve the availability of local services.

California↗
PubMed1989

Medical indigency and inner city hospital care: patient dumping, emergency care and public policy.

This paper discusses the growing lack of private for-profit hospital care for the medically indigent. The issues of patient dumping and emergency care are examined from both judicial and public policy perspectives. The paper concludes by noting that dumping may be viewed as a most serious form of neglect and more comprehensive laws and court decisions are needed to require all hospitals, regardless of ownership, to treat all patients who arrive at their doors if they have the appropriate medical staff and facilities.

Emergency Service, Hospital↗
PubMedDate not supplied

A model for primary care delivery to a widely dispersed medically indigent population.

Access to Care is a unique program uniting private and public resources to provide primary care to the uninsured poor. The model was designed to serve a medically indigent population that is dispersed over a large geographic area, where clinics are not a practical option. Care for illness is provided in the offices of private physicians throughout the area and supported by laboratory, radiology, and pharmacy services. The program is designed for the estimated 88,000 persons in suburban Cook County, Illinois, with family incomes of less than twice the federal poverty level, who are uninsured and ineligible for Medicaid and Medicare. Supported by grants from foundations and local governments, the program, which has been in operation for 2 years in two demonstration areas, is administered by a private not-for-profit confederation of four health and social service organizations.

Delivery of Health Care↗
PubMed1998

Low rate of breast conservation surgery in large urban hospital serving the medically indigent.

BACKGROUND: Breast conservation surgery (BCS) with radiation therapy is an acceptable treatment for stage I and II breast carcinoma. The purpose of this study was to measure the use of BCS in a large, urban, university-affiliated hospital serving primarily medically indigent patients. METHODS: A chart review of patients receiving operative treatment for breast carcinoma during 1995 and 1996 was done. Patients with stage I or II disease were selected. Data were analyzed for clinical stage, surgical treatment, age, and ethnic origin. RESULTS: Of patients eligible, only 16% received BCS. There were slight trends for younger women to receive BCS and for decreased use of BCS with stage II disease. No differences in surgical treatment were seen across ethnic groups. CONCLUSIONS: We suggest that poverty, poor education, and cultural differences may play a role in selection of surgical treatment for breast carcinoma. Further investigation is needed to facilitate best treatment.

Adult↗
PubMed1995

Conservative treatment of early-stage breast cancer in a medically indigent population.

The compliance with a program of breast-conservation treatment for early-stage breast cancer and the results of that treatment among women treated between January 1983 and January 1992 was investigated in a large inner-city public hospital serving a primarily black population. Medical records and charts were reviewed for 25 consecutive patients with stage I and II breast cancer seen in consultation in the radiation oncology department. Of those 25 patients, 20 underwent lumpectomy and radiation therapy. Survival, disease-free survival, and local recurrence-free survival were computed using the Kaplan-Meier method. Compliance was evaluated based on time to complete the prescribed course of radiotherapy after a lumpectomy. Five-year local recurrence-free survival for stage I and II patients was 95% (confidence interval [CI]: 71% to 99%). Five-year overall survival for stage II patients was 71% (CI: 31% to 92%), and disease-free survival was 74% (CI: 36% to 91%). This study demonstrates that a program of breast-conservation treatment for early-stage breast cancer can be implemented with good results, excellent treatment compliance, and 100% follow-up in a population of medically indigent women.

Adult↗
PubMed1989

Prescription drug coverage and medical indigence among the elderly.

When Medicare extends catastrophic coverage to outpatient prescription drugs in 1991, the program will benefit an estimated 15% to 25% of the aged population. For some of these individuals Medicare coverage will mean the difference between economic self-sufficiency and impoverishment due to high medical bills. This article provides empirical estimates of the relationship between third-party coverage of outpatient pharmaceuticals and the risk of medical indigence based on the experience in Pennsylvania following enactment of that state's Pharmaceutical Assistance Contract for the Elderly (PACE), a lottery-financed drug benefit program that currently enrolls nearly half a million residents age 65 and older. The study provides data on the distribution of billed charges for outpatient drugs by income class for PACE enrollees and then uses a time series analysis to estimate the impact of PACE implementation (July 1984) on monthly changes in Medicaid enrollments and expenditures by category of elderly Medicaid recipient over the period July 1981 through June 1987. Study findings are discussed in the context of the forthcoming Medicare drug benefit.

Aged↗
PubMedDate not supplied

Medically indigent women seeking abortion prior to legalization: New York City, 1969-1970.

If the efforts now underway to limit access to abortion services in the United States are successful, their greatest impact will be on women who lack the funds to obtain abortions elsewhere. There is little published information, however, about the experience of medically indigent women who sought abortions under the old, restrictive state laws. This article details the psychiatric evaluation of 199 women requesting a therapeutic abortion at a large municipal hospital in New York City under a restrictive abortion law. Thirty-nine percent had tried to abort the pregnancy. Fifty-seven percent had concrete evidence of serious psychiatric disorder. Forty-eight percent had been traumatized by severe family disruption, gross emotional deprivation or abuse during childhood. Seventy-nine percent lacked emotional support from the man responsible for the pregnancy, and the majority were experiencing overwhelming stress from the interplay of multiple problems exacerbated by their unwanted pregnancy.

Abortion, Legal↗
PubMedDate not supplied

Early postpartum rooming-in and maternal attachment behaviors in a group of medically indigent primiparas.

Introduction of rooming-in at the study site provided an opportunity to examine the impact of rooming-in on maternal attachment behaviors. Maternal attachment scores for 80 mothers who received rooming-in were compared to 72 mothers who delivered before rooming-in and 35 mothers who requested but did not receive rooming-in. All subjects were medically indigent primiparas with no intrapartum or postpartum complications and term healthy infants. The groups were not significantly different in maternal age, race, or ethnicity. Maternal attachment behaviors were recorded during an infant feeding. Rooming-in mothers had significantly higher maternal attachment scores than both control groups. Rooming-in had an independent effect on maternal attachment after the effects of maternal age, episiotomy or lacerations, epidural anesthesia, infant contact at delivery, and time of feeding observation had been accounted for. Of these prior factors, only maternal age had a significant impact on rooming-in. These results suggest that rooming-in helps primiparas to form early attachments to their babies, and that the impact of rooming-in cannot be explained by the mother's motivation for rooming-in. It is important to provide close contact with the infant during the early postpartum, especially for adolescents who may be at higher than average risk of mothering inadequacies.

Adolescent↗