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PubMed1987

Immunization coverage in Italy.

In Italy information on immunization coverage against pertussis, measles, and rubella is absent or incomplete. In 1985 the Istituto Superiore di Sanità (ISS) organized a series of immunization coverage surveys for these diseases in several local health units (Unità Sanitaria Locale) (USL). The surveys were conducted simultaneously in 80 USLs in 1985 with modified EPI cluster sampling techniques, using schools attended by children aged 3 to 10 years as the clusters. Information on previously performed immunizations was collected for each child sampled. The total immunization coverage and proportion of immunized children in eight birth cohorts were calculated.Low immunization coverage was reported by the USLs surveyed, and regional differences in the coverage were apparent between the north, centre, and south of Italy. In addition, a steady or decreasing trend in the use of pertussis vaccine was found, while an increasing coverage was observed for measles and rubella immunizations.

Child↗
PubMed1982

Carotid rupture and tissue coverage.

Carotid rupture following the treatment of head and neck malignancy is the most dreaded complication faced by the head and neck surgeon. Tissue coverage of the carotid artery has been advocated as the method of protection likely to prevent carotid rupture. A retrospective study was carried out to assess the benefit of carotid coverage and whether such protection plays a role in decreasing mortality and morbidity. A brief history of carotid protection is presented. A series of 194 head and neck cancer patients who underwent resection of their mucosal primary in continuity with radical neck dissection over a ten-year period was reviewed. No coverage was used in 120 cases, while 72 cases received carotid coverage. There was a 13% fistula rate and a 15% rate of wound complication without fistula. Six patients without recurrence who had carotid rupture or ligation for imminent rupture were identified. This group was scrutinized with regard to several parameters. Three received tissue coverage of the carotid system, while the other three were left unprotected. There was 50% mortality rate and 25% rate of neurologic sequelae amongst the survivors. This review tends not to support the premise that tissue coverage is a major factor in the prevention of carotid rupture.

Carotid Artery Diseases↗
PubMed1995

Explaining trends in health insurance coverage between 1988 and 1991.

This paper uses regression-based decompositions to examine the downward trend in insurance coverage between 1988 and 1991. I find that falling family incomes account for much of the decline in overall insurance coverage, while a secular decline in insurance coverage across all industries, firm sizes, employment statuses, income levels, and demographic groups accounts for most of the decline in employer-sponsored insurance among workers. Rising unemployment and changing patterns of industrial employment explain little of the decline in coverage across the entire population. Taken together, these results suggest that fewer employers are offering health coverage, workers are finding it difficult to pay their share of the premiums, and those without access to employer-sponsored plans are finding it harder to purchase nongroup insurance. Thus, it appears that the rising cost of health insurance coupled with falling incomes and profits during the recession account for the fall in health insurance coverage between 1988 and 1991.

Family↗
PubMed1994

Pension coverage among the baby boomers: initial findings from a 1993 survey.

Using data from a series of supplements to the Current Population Survey, this article presents findings on workers' coverage under employer-sponsored retirement plans in 1993, and recent trends in coverage. The analysis focuses on workers 25-54, a group that includes the baby boom generation. Among all wage and salary workers in this age range (including government employees and part-time workers), 55 percent reported participating in a retirement plan on their current primary jobs, and an additional 3 percent were covered from other jobs. After a modest decline in the early 1980's, the coverage rate has remained essentially unchanged over the past 10 years, and limited data suggest that the baby boomers are doing about as well on pension coverage as older workers at similar points in their careers. Beneath this relative stability in overall coverage, however, at least two important changes have occurred: a significant narrowing of the gender gap in coverage and a shift in types of retirement plans. Increasing numbers of workers are being covered solely by 401(k)-type plans, a development that raises new uncertainties about the form and amount of future benefits. On the other hand, limited data in this study suggest that 401(k) plans may be serving their intended purpose for the majority of workers who have them.

Adult↗
PubMed1994

Resection specimen analysis of tibial coverage in total knee arthroplasty.

To maximize tibial coverage during total knee arthroplasty, a study was performed to evaluate the morphology of the proximal tibia at the resection level and assess tibial coverage with respect to existing tibial implants. Unmagnified radiographs of 42 tibial resection specimens were produced and digitized with existing tibial implants from the asymmetrical Genesis and the symmetrical Insall-Burstein II and Press Fit Condylar total knee arthroplasty designs. The average total profile coverage ranged from 80.62% to 84.73%, whereas the average posteromedial coverage ranged from 76.05% to 82.09%. The shape of the tibia at the resection level was asymmetrical, and the overall tibial coverage was never greater than 85%. It appears that the actual shape of the tibial tray and the number of accommodating sizes provide the best ability of a total knee arthroplasty system to maximize tibial coverage, and not simply an asymmetrical or a symmetrical design.

Humans↗
PubMed1993

[The medical care and vaccinal coverage of the children of Filipino mothers].

We present data on the access to health care services and vaccination coverage of a sample of children born to Filipino mothers in the city of Barcelona (Spain). The sample was obtained by snowball sampling from the community reference centers for the identified migrant Filipino population. Access to public health care services is much lower for this population than for the whole population, which causes use of private services to compensate for this shortcoming. The causes are related to the residence and working status of a segment of this migrant population. Vaccination coverage for two and three year olds was 68% for measles, mumps and rubella, 52% with four doses for polio, diphtheria and tetanus and 48% with four doses for pertussis. Vaccination coverage is slightly higher for four and five year olds, with a coverage of 73.9% for measles, 69.5% for mumps and rubella and 73.9% with four doses for polio, diphtheria and tetanus, and 69.5% with four doses for pertussis. Vaccination coverage of 6 to 14 year old children is much lower. It is possible that real vaccination coverage is higher, but vaccination cards or records have been lost by the families. These results are much lower than global vaccination levels for the city, but comparable to those described in the inner city district where most of these children live. The causes of this situation, their implications and how to improve them are discussed.

Adolescent↗
PubMed1993

Pap smear coverage among rural workers.

Despite the high incidence of cancer of the uterine cervix among black South African women, many do not have access to cytological screening services. Data describing Papanicolaou smear coverage and factors related to coverage are presented from 9 surveys of rural women workers in the food canning and processing industry in the Cape. Adequacy of Pap smear coverage was assessed according to whether the respondent had ever previously had a Pap smear, or had had one in the 3 years preceding the survey. From the 3 surveys with the greatest generalisability, only 49-65% of workers reported adequate Pap smear coverage. Knowledge about Pap smears was lacking. At the same time, of those women with adequate coverage, many appeared to be receiving unnecessary routine Pap smears. It appears that the policy which makes the availability of Pap smears dependent upon acceptance of contraceptive services is responsible for both the lack of Pap smear coverage and the over-provision of smears in this group of women. An urgent review of state Pap smear policy is required and a coherent community-based educational programme to facilitate the prevention of cervical cancer should be implemented as soon as possible.

Adolescent↗
PubMed1996

Effect of an immunisation campaign in Natal and KwaZulu on vaccinaton coverage rates, 1990-1991.

In 1990 the Department of National Health and Population Development of South Africa launched a nationwide immunisation campaign targeted mainly at measles. In order to measure the effect of the campaign on vaccination coverage rates for children, pre- and post- campaign vaccination coverage surveys were undertaken using a modified Expanded Programme for Immunisation technique, stratified for race and urban/rural residence. The results in KwaZulu-Natal showed no significant increase in measles vaccination coverage for any race rates after the campaign (as documented by Road-to-Health cards). There was a decrease in coverage of the black population. However, when a history of measles vaccination was accepted, the results showed an increase in coverage. The results call into question the effectiveness of immunisation campaigns as a strategy for raising vaccination coverage levels, as well as their having a sustained impact on the incidence of measles. Alternative strategies, such as the strengthening and expansion of existing primary health care services, should be considered.

Child, Preschool↗
PubMed1996

[Child vaccination: the coverage, knowledge and attitudes of the population. A study in a health area].

The purpose of this study was to know the vaccination coverage in children under 16 years of age in our health care area, as well as the level of knowledge, attitudes, beliefs, vias of information and other factors that could influence the state of child vaccination. A transverse study by interviewing parents was made. Children were distributed into three groups: A (0 to 4 years of age), B (5 to 9 years of age) and C (10 to 16 years of age). Our results showed a correct global vaccination coverage rate of 58.4%. The correct vaccination coverage rate 94.5% in group A, 74.7% in group B and 30.8% in group C (p < 0.001). The correct coverage for specific vaccinations was: measles 74.6%, rubella 69%, mumps 63.1%, diphtheria-tetanus-pertussis and polio 67.6%. This coverage was also greater in the younger children. There was no statistical difference among the several basic health zones. Of those parents interviewed, 94.8% thought that vaccines were good for health. Their knowledge about dosage, the administration frequency and the different diseases and their complications was suitable. Information about vaccinations was received from pediatricians in 31.3% of the cases and from nurses in 24.8%, with the majority of the cases classifying the information as sufficient, although 36.8% classified it as deficient. There were no statistical differences of the vaccination status according to sex, family size, numerical order in the family, or if the children were from an urban zone or a rural zone. However, there was a statistical difference according to the parent's intellectual level. In conclusion, the vaccination coverage found in children up to 4 years old was very suitable, but it was worse in older children. The level of knowledge and attitude was also suitable; however better health and vaccination education is necessary.

Adolescent↗
PubMed1978

Health service coverage and its evaluation.

Health service coverage is considered as a concept expressing the extent of interaction between the service and the people for whom it is intended, this interaction not being limited to a particular aspect of service provision but ranging over the whole process from resource allocation to achievement of the desired objective. For the measurement of coverage, several key stages are first identified, each of them involving the realization of an important condition for providing the service; a coverage measure is then defined for each stage, namely the ratio between the number of people for whom the condition is met and the target population, so that a set of these measures represents the interaction between the service and the target population. This definition of coverage allows for variations, which are called "specific coverage", by limiting the target population to specific subgroups differentiated by certain conditions related to service provision or by demographic or socioeconomic factors.The evaluation of coverage on the basis of these concepts enables management to identify bottlenecks in the operation of the service, to analyse the constraining factors responsible for such bottlenecks, and to select effective measures for service development.

Cost-Benefit Analysis↗
PubMed1999

Measuring immunisation coverage in Australia. A review of the Australian Childhood Immunisation Register.

BACKGROUND: Before the establishment of the Australian Childhood Immunisation Register (ACIR), measurement of childhood immunisation coverage in Australia involved a variety of methods at varying intervals by general practice (GP) divisions, state health departments and the Australian Bureau of Statistics. Such surveys may underestimate (child health records) or overestimate (parental recall) true immunisation coverage. OBJECTIVE: The establishment of the ACIR in 1996 (a world first), was a huge undertaking involving 15,000 immunisation providers (60% GPs) notifying over 3 million immunisations annually. This review summarises the operation of the ACIR, how it calculates coverage, the accuracy of estimates from the ACIR and how Australia's immunisation coverage compares with that of other similar countries. Currently, the accuracy of the records on the register is questioned, especially in urban areas, but available data suggest that failure to report to the ACIR is the main source of data discrepancies. DISCUSSION: The ACIR has the potential to measure immunisation coverage at any practice or local level with accuracy and timeliness. With full provider participation, the ACIR is capable of identifying areas of low immunisation coverage for targeted interventions and will play a key role in the current measles campaign, the General Practice Immunisation Incentives scheme and in payments to parents. Achieving the highest possible completeness and timeliness of the ACIR is in the interests of providers, consumers and health planners.

Australia↗
PubMed2004

Impact of prescription coverage on hospital and physician costs: a case study of medicare beneficiaries with chronic obstructive pulmonary disease.

BACKGROUND: It is widely believed that appropriate use of prescription medicines can reduce avoidable hospitalizations and more expensive nonpharmacologic therapies, but identifying such cost offsets in operational programs is elusive. Any possible impact would be most apparent in patients with medication-sensitive disease conditions, such as chronic obstructive pulmonary disease (COPD). OBJECTIVE: The goals of this study were to develop an observational study design appropriate for estimating potential cost savings in the US Medicare budget as a result of extending drug coverage to persons with particular chronic diseases and to apply these study methods, in an exploratory analysis, to a sample of Medicare beneficiaries with COPD. METHODS: Spending for drugs, hospitalizations, and physician services was compared for COPD patients with and without prescription coverage using data from the 1999 and 2000 US Medicare Current Beneficiary Survey. To control for channeling bias, multivariate matching on observable variables was combined with tests for missing variable bias. The matching algorithm used propensity score weighting to ensure comparability between the 2 groups on all observed characteristics at baseline. RESULTS: Our sample comprised 462 beneficiaries with prevalent COPD in the year 2000: 384 (83.1%) had prescription coverage the entire year and 78 (16.9%) had no coverage. After adjustment, drug coverage was associated with 61% higher spending on medications and 29% lower spending on physician services (both, P < 0.05). Hospital costs appeared slightly lower for those with drug benefits, but the difference was not statistically significant. No statistically significant effects were found for services specific to COPD. However, effect sizes were large even for nonsignificant findings. CONCLUSIONS: Although this analysis did not establish a strong causal link between drug benefits and lower costs, 11 of our 12 comparisons had signs consistent with the cost-offset hypothesis.

Aged↗
PubMed2003

Welfare reform and health insurance coverage of low-income families.

We study whether welfare reform adversely affected the health insurance coverage of low-educated single mothers and their children. Specifically, we investigate whether changes in the welfare caseload during the 1990s were associated with changes in Medicaid participation, private insurance coverage, and the number of uninsured among single mothers and their children. Estimates suggest that between 1996 and 1999, the 42% decrease in the welfare caseload was associated with the following changes in insurance coverage among low-educated, single mothers: a 7-9% decrease in Medicaid coverage; an increase in employer-sponsored, private insurance coverage of 6%; and a 2-9% increase in the proportion uninsured. Among children of low-educated, single mothers, effects were somewhat smaller. Since welfare policy was responsible for only part (e.g. one-third) of the decline in the caseload, welfare reform per se had significantly smaller effects on the health insurance status of low-income families. However, we found limited evidence that changes in the caseload due to state and federal welfare policy had fewer adverse consequences on insurance status than changes in the caseload due to other factors. This implies even smaller effects of welfare reform.

Adolescent↗
PubMed2005

The demand for dependent health insurance: how important is the cost of family coverage?

From the mid-1980s to the mid-1990s, the proportion of non-elderly Americans with employment-based health insurance declined. Roughly 80% of this decline was due to the loss of coverage by dependent family members. During this period, workers became increasingly responsible for the costs of family coverage, while expanded Medicaid coverage provided low-income working families with an alternative to employment-based insurance. We examine the role of out-of-pocket premiums and expanded Medicaid eligibility in households' demand for employment-based family coverage. Cross-sectional results reveal that demand is affected by both factors. We find that between 1987 and 1996, the increase in out-of-pocket premium costs accounted for nearly half of the decline in dependent coverage while expanded Medicaid eligibility represented 14% of the decline.

Adolescent↗
PubMed2002

Physician smoking-cessation actions: are they dependent on insurance coverage or on patients?

BACKGROUND: Despite good evidence that their smoking-cessation actions can be very effective, physicians have not consistently used the 5A actions (being asked, advised, assessed, assisted, and arranged) recommended in the U.S. Public Health Service tobacco guidelines. We tested the hypothesis that the introduction of coverage for smoking-cessation pharmacotherapy by the health plans covering most of the population in one region would increase physician use of 5A's. METHODS: A cohort of smoking members of two health plans was surveyed before and after the introduction of coverage for smoking cessation. A total of 1560 current smokers with a physician visit in the last year responded to both surveys. The key outcome measures were smoker reports of the guideline 5As for smoking-cessation support during the last physician visit. RESULTS: There were small significant absolute percentage increases only for reports of being assessed (+4.9%, p=0.01) and assisted (set quit date +6.5%, p=0.0004); encouraged to use medications (+8.8%, p=0.03); and given a prescription (+8.6%, p=0.0005). However, these increases were limited to smokers reporting awareness of the coverage, asking for quitting help, or both. CONCLUSION: Coverage for pharmacotherapy alone appears to have had no effect on physician behavior beyond that stimulated by smokers who were aware of the coverage, perhaps because they raised the issue. More research is needed on this suggestion that patients create physician behavior change.

Chi-Square Distribution↗
PubMedDate not supplied

Gender impacts on health insurance coverage: findings for unmarried full-time employees.

Probit regression is applied to a sample of fully employed unmarried respondents from the 1996 Medical Expenditure Panel Survey to determine the likelihood of private health insurance vs. no insurance coverage. Gender-related employment segregation is a strong indicator for insurance coverage, since those in male-dominated industries are more likely to have coverage. The strong impact of unions and number of plans offered on insurance coverage suggests that insurance purchasing cooperatives and managed competition may increase availability of affordable coverage, thus alleviating some of the financial barriers to health care.

Adult↗
PubMed2003

Improvements in prenatal insurance coverage and utilization of care in California: an unsung public health victory.

OBJECTIVE: To examine trends in prenatal insurance coverage and utilization of care in California over two decades in the context of expansions in Medi-Cal (California's Medicaid) and other public efforts to increase prenatal care utilization. METHODS: Retrospective univariate and bivariate analysis of prenatal care coverage and utilization data from 10,192,165 California birth certificates, 1980-99; descriptive analysis of California poverty and unemployment data from the U.S. Census Bureau Current Population Survey; review of public health and social policy literature. RESULTS: The proportion of mothers with Medi-Cal coverage for prenatal care increased from 28.2 to 47.5% between 1989 and 1994, and the proportion uninsured throughout pregnancy decreased from 13.2 to 3.2%. Since the mid-1990s, fewer than 3% of women have had no insurance coverage for prenatal care. Between 1989 and 1999, the proportion of women with first trimester initiation of prenatal care increased from 72.6 to 83.6%, reversing the previous decade's trend, and the proportion of women with adequate numbers of visits rose from 70.7 to 83.1%. Improvements in utilization measures were greater among disadvantaged social groups. Improvements in California during the 1990s coincided with a multifaceted public health effort to increase both prenatal care coverage and utilization, and do not appear to be explained by changes in the economy, maternal characteristics, the overall organization/delivery of health care, or other social policies. CONCLUSIONS: While this ecologic study cannot produce definitive conclusions regarding causality, these results suggest an important victory for public health in California.

Adolescent↗
PubMed2004

Coverage of cataract surgery per person and per eye: review of a community-based blindness survey in Oman.

BACKGROUND AND OBJECTIVE: The data from a national survey of blindness and common eye diseases in Oman in 1996 were reviewed. The objective was to compare the calculation of cataract surgery services coverage on a per eye and per person basis. The advantages and limitations of both methods of program management are evaluated. METHODS AND MATERIALS: The information on cataract status, visual status and past history/evidence of cataract surgery was collected for 11,415 Omani subjects. The coverage of existing cataract services was calculated per eye and per person. The rates by gender, age groups, regional groups and type of cataract were also compared. RESULTS: The cataract surgery services could address more than 60% of the reported persons with blinding cataract (vision less than 3/60) and more than half of the eyes with blinding cataract. The services could cover more than one-fourth of the persons with cataract (with any grade of vision defect) and less than one-fourth of the eyes with cataract. If the coverage of cataract services for blinding cataract is calculated using persons as the denominator, it is nearly 10% higher than that calculated using eyes as the denominator. CONCLUSIONS: The two methods of calculating the coverage of cataract services give different results and both are useful for monitoring ophthalmic services. A national program should implement a system for reporting the visual and cataract status of the fellow eye so that coverage rates could be calculated by person and by eye and the impact of the cataract services in relation to time, place, gender and resources could be reviewed.

Adult↗