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Results for “Medical Indigency”

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At least 55 records · Page 3Linked to original sources
PubMed2003

Breast conservation therapy rates are no different in medically indigent versus insured patients with early stage breast cancer.

PURPOSE: Multiple prospective, randomized studies show that breast conservation therapy (BCT) results in survival rates equal to mastectomy (Mx) for patients with early stage breast cancer (ESBC). Nevertheless, BCT remains underused in certain areas of the nation, without clearly definable reasons. Several studies have implicated socioeconomic status as one potential cause for this disparity in BCT usage. We sought to compare BCT rates in the medically indigent versus insured patients, within the same institution. METHODS: Data from 1993 to 2000, collected from the institutional tumor registry and the hospital's claims records, were analyzed for 928 patients with ESBC (Stages 0, I, and II), treated at a single medical center. The same surgeons treated both insured and indigent patients. Patients treated by BCT or Mx were compared for age, race, stage, insurance status, access to a radiation therapy center, surgeon, and year of diagnosis. RESULTS: Patient age, race, surgeon, or insurance status did not significantly affect the rate of mastectomy. Stage I patients (P < 0.001) and those treated after 1995 had higher BCT rates (54.9% in 1993-95 vs. 70.7% in 1996-2000; P < 0.001). Travel distance to a radiation therapy center had no significant impact on BCT rates, except for patients >40 miles distant. CONCLUSIONS: These data refute the hypothesis that socioeconomic status, as reflected by medical insurance, is a determinant of BCT in women with ESBC. Distance of <40 miles to a radiation therapy facility, Stage I disease, and diagnosis after 1995 were factors associated with higher BCT rates.

Breast Neoplasms↗
PubMed1993

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

Because no national health program assures entitlement to basic services, advocates must cope with barriers to access on the local level. The authors report several strategies that a community-based coalition has used to improve indigent care in one county. Research strategies have involved short-term investigations of barriers to needed services. Political strategies have attempted to improve the county government's administrative procedures and financial support of services for the poor. Legal strategies have involved the participation of attorneys who represent clients unable to receive care. Although such advocacy efforts do not guarantee access, they can substantially improve the availability of local services.

California↗
PubMed2006

Effect of a global longitudinal pathway on medical students' attitudes toward the medically indigent.

BACKGROUND: The increase in people with insufficient health insurance has largely been fueled by a record influx of immigrants, who often live in medically underserved areas of inner cities. An increase in the desire of medical students to practice in underserved areas is needed to counter low physician-to-population ratios in these areas. PURPOSE: To assess the effect of a Pathway on Serving Multicultural and Underserved Populations, which includes domestic and international experiences with recent immigrant groups, on the attitudes of students toward the indigent. METHODS: Students from the classes of 2002 and 2003, including a cohort in the Pathway program, were participants in this study. Changes in attitudes within Pathway and non-Pathway students were studied over their 4 years of medical school. RESULTS: There was no statistically significant difference between the two groups in the rate of change of attitudes over time. The determination of any potential difference was hampered by small sample sizes. Thus, interesting trends, especially related to a more rapid decline in attitudes of non-Pathway students, including their sense of professional responsibility, did not achieve statistical significance. CONCLUSIONS: Further research, both quantitative and qualitative, is needed before we can state more definitively that the Pathway curriculum supports positive attitudes toward serving the medically indigent.

Adult↗
PubMed1993

Primary care program improves reimbursement. The Federally Qualified Health Center program helps hospitals improve services to the medically indigent.

Under a program created by Congress in 1989, certain primary care treatment centers serving the medically and economically indigent can become Federally Qualified Health Centers (FQHCs). Recently enacted rules and regulations allow participants in the FQHC program to receive 100 percent reasonable cost reimbursement for Medicaid services and 80 percent for Medicare services. An all-inclusive annual cost report is the basis for determining reimbursement rates. The report factors in such expenses as physician and other healthcare and professional salaries and benefits, medical supplies, certain equipment depreciation, and overhead for facility and administrative costs. Both Medicaid and Medicare reimbursement is based on an encounter rate, and states employ various methodologies to determine the reimbursement level. In Illinois, for example, typical reimbursement for a qualified encounter ranges from $70 to $88. To obtain FQHC status, an organization must demonstrate community need, deliver the appropriate range of healthcare services, satisfy management and finance requirements, and function under a community-based governing board. In addition, an FQHC must provide primary healthcare by physicians and (where appropriate) midlevel practitioners; it must also offer its community diagnostic laboratory and x-ray services, preventive healthcare and dental care, case management, pharmacy services, and arrangements for emergency services. Because FQHCs must be freestanding facilities, establishing them can trigger a number of ancillary legal issues, such as those involved in forming a new corporation, complying with not-for-profit corporation regulations, applying for tax-exempt status, and applying for various property and sales tax exemptions. Hospitals that establish FQHCs must also be prepared to relinquish direct control over the delivery of primary care services.

Centers for Medicare and Medicaid Services, U.S.↗