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At least 631 records · Page 35Linked to original sources
PubMed2000

Uninsured and unstably insured: the importance of continuous insurance coverage.

OBJECTIVE: To examine the importance of continuous health insurance for access to care by comparing the access and cost experiences of insured adults with a recent time uninsured to the experiences of currently uninsured adults and experiences of adults with no time uninsured within a reference time period (continuously insured). DATA SOURCES: Adults ages 18-64. Data draw from three different survey databases: the Robert Wood Johnson Foundation 1996-1997 Community Tracking Survey, the Kaiser/Commonwealth 1997 National Survey of Health Insurance, and the 1995-1997 Kaiser/Commonwealth State Low Income Surveys. STUDY DESIGN: The study groups individuals into three insurance categories based on respondents' reports of insurance coverage within a reference time period: continuously insured; insured when surveyed but with recent time uninsured; and currently uninsured. In the two Kaiser/Commonwealth surveys the recently uninsured group included any insured respondent with a time uninsured in the past two years. In the Community Tracking Survey, the recently uninsured group included any insured respondent with a time uninsured in the past year. Measures of access include foregoing health care when needed, usual source of care, use of health care services, difficulties paying for medical care, and satisfaction with care. DATA COLLECTION: All three surveys were conducted primarily by telephone. The Community Tracking Survey drew from 60 community sites, with an additional random national sample. The Kaiser/Commonwealth National Survey was a random national sample; the Kaiser/Commonwealth State Low Income Surveys included adults ages 18-64 with incomes at or below 250 percent of poverty in seven states: Minnesota, Oregon, Tennessee, Florida, Texas, New York, and California. PRINCIPAL FINDINGS: Compared to the continuously insured, those insured but with a recent time uninsured were at high risk of going without needed care and of having problems paying medical bills. This group was two to three times as likely as those with continuous coverage to report access problems. Rates of access and cost problems reported by insured adults with a recent time uninsured neared levels reported by those who were uninsured at the time of the survey. These two groups also rated care received more negatively than did adults with continuous insurance coverage. In general, the access gap between persons insured and uninsured widened as a result of distinguishing insured adults with a recent time uninsured from insured adults with no time uninsured. CONCLUSION: Studies that focus on current insurance status alone will underestimate the extent to which having a time uninsured during the year contributes to access difficulties and undermines quality of care, and will underestimate the proportion of the population at risk because they are uninsured. Policy reforms are needed to maintain continuous insurance coverage and avoid spells uninsured. Currently uninsured and unstably insured adults are both at high risk.

Adolescent↗
PubMed2001

Wisconsin's BadgerCare program offers innovative approach for family coverage.

Wisconsin's BadgerCare program is viewed by many as a model for how other states could pursue comprehensive health insurance coverage for lower income families. The program provides health insurance to working families - both children and their parents - and seeks to eliminate barriers to successful employment by providing a transition for families from welfare to private insurance. BadgerCare's success is founded on its family coverage approach, its single point of entry and administrative seamlessness, and the political commitment to the program from Governor Tommy G. Thompson. In 1999 and 2000, New York, New Jersey, and the Clinton administration recognized the importance of a family-based approach to children's coverage by proposing, and in the states' case, implementing some variation of the Wisconsin model. Other states have indicated interest in covering families and look to the flexibility of the Health Care Financing Administration's (HCFA) recent ruling on 1115 demonstration projects to cover parents using the enhanced State Children's Health Insurance Program (SCHIP) match. This case study details the BadgerCare program and its impact on the uninsured in Wisconsin, including how the program approaches enrolling families, how family coverage is financed, how the program partners with private insurance, and what cost-sharing obligations exist.

Adult↗
PubMed2004

Trends in health insurance coverage and access among black, Latino and white Americans, 2001-2003.

Overall health insurance rates changed little among nonelderly black, Latino and white Americans between 2001 and 2003, according to new findings from the Center for Studying Health System Change (HSC). But sources of coverage shifted--especially for Latinos--from employment-based insurance to public coverage, suggesting the economic downturn took a greater toll on Latinos. Low-income Latinos and whites were particularly hard hit by declines in employer coverage. Shifting sources of coverage had little effect on access to medical care. With the sole exception of decreased access to specialists among blacks, access to care did not change between 2001 and 2003. Significant gaps in access to care among Latinos, blacks and whites persisted, with Latinos and blacks consistently reporting lower levels of access than whites.

Adult↗
PubMed2005

Options for federal coverage of the uninsured in 2005.

Current approaches to reducing the number of uninsured include insurance tax credits for individuals and employers, expanding private group coverage, expanding eligibility for public programs, creating new public programs, and reforming insurance markets. Proposals vary in how they would expand coverage, how many uninsured would be covered, and how much they would cost. Although the costs of expanding coverage are significant, so are the costs of high uninsured rates. Moreover, expanding coverage would likely lead to substantial gains in health and productivity.

Federal Government↗
PubMed2005

Federal aid to state high-risk pools: promoting health insurance coverage or providing fiscal relief?

To help people whose health conditions make it difficult for them to obtain insurance coverage, the Trade Act of 2002 initiated federal matching payments to support state high-risk pools and promote coverage expansion through them. Some 30 states already had high-risk pools, but enrollment was very limited, largely because of high premiums, exclusion of coverage for preexisting conditions, and high cost-sharing. In interviewing officials from high-risk pools that received grants in the program's first year, the authors found that most states did not use grant funds to make their pools more accessible or affordable; instead, 18 of 19 states used some or all funds to refinance existing programs. Only one state used its entire grant award to reduce enrollee premiums, expand covered benefits, or otherwise enact changes to promote enrollment. Policymakers may need to strengthen grant requirements and/or financial incentives to promote expansion of coverage via state high-risk pools.

Consumer Behavior↗
PubMed2006

From SCHIP benefit design to individual coverage decisions.

The majority of states have implemented separate SCHIP (S-SCHIP) programs that significantly depart from Medicaid and resemble less comprehensive commercial products. This difference in program design may result in S-SCHIP potentially being less responsive to children with special needs (CSHCNs). This study explores how responsive insurers are to these higher than average needs. We found that, with one exception, insurers did not agree on the coverage of any specific service, but overall they provided coverage beyond state limits and exclusions. Second, the less acute the childhood condition, the more frequently insurers imposed exclusions. Finally, in the majority of states, some insurers excluded services that arguably should have been covered according to the plan/contract language. We conclude that SCHIP coverage at current levels may not be sufficient to care for CSHCNs, making external reviews of insurers' coverage decisions and coordination with other sources of care important components of SCHIP program design.

Child↗
PubMed2005

Medicare reimbursement for clinical trial services: understanding Medicare coverage in establishing a clinical trial budget.

In designing and setting up a clinical trial, investigators and private sponsors must take into account what costs will or will not be covered by third-party insurers and government payment programs like Medicare and Medicaid. Failure to "cost out" the clinical trials accurately can yield one of two results: either third-party payors are billed improperly, or even illegally, for experimental care, or significant research-related care is not billed, with either the investigating institution, or the research subjects themselves, shouldering the cost. Unfortunately, because Medicare has established different coverage principles to be applied depending on the type of trial being conducted, costing out the trial is not an easy task. This Article looks at the various Medicare coverage principles as they apply to clinical trials, including the 2000 National Coverage Decision and the recent expansion in coverage for Class A Investigational Devices created by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The Article then examines how the Medicare secondary payor rule, which states that providers may not bill Medicare for items or services when another party has primary responsibility for those services, relates to clinical trails in light of recent commentary. The Article concludes with the presentation of a general framework that investigators can use to establish a clinical trial budgeting and billing system.

Budgets↗
PubMed2006

One in five Californians were uninsured in 2005 despite modest gains in coverage.

Six and one-half million Californians were uninsured for all or some of 2005, a number that is as large as the combined populations of nine other states. The number of uninsured represented one in five children and nonelderly adults, a rate that was slightly lower than in 2003 due to California's tight labor markets and expanding enrollment and retention in California's public coverage programs for children. These marginal improvements are unlikely to continue unabated given the instability of employment-based insurance coverage in the face of rising costs. In this policy brief, we compare insurance coverage over time using the California Health Interview Surveys conducted in 2001, 2003 and 2005. We look at the type of coverage over the past 12 months for both children and nonelederly adults.

Adult↗
PubMed1997

Changes in the 1995 Current Population Survey and estimates of health insurance coverage.

This analysis compares the March 1994 and March 1995 Current Population Survey (CPS) counts of the numbers of people with different types of health insurance and without any health insurance coverage. The findings contain some surprises: there were no changes in the numbers of nonelderly people with Medicaid coverage and without any health insurance, and there were increases in the numbers of nonelderly people with employer-sponsored health insurance and with CHAMPUS/VA/military health care. Four changes were introduced in the CPS in 1995 and were likely, by themselves, to both raise and lower the estimates of the numbers of people with specific types of health insurance coverage. Three of the changes relate to questions about health insurance coverage; they coincide with the traditional mid-decade shift in the sample framework for the CPS.

Adult↗
PubMed1997

Differences in private health insurance coverage for working male Hispanics.

In 1993, 33.8% of all nonelderly adult Hispanics living in the United States lacked health insurance coverage (either private or public), compared to 8.1% of the entire nonelderly population. Because Hispanics are more likely to be uninsured than any other ethnic group and because they are the fastest growing minority group in the United States, the increase in the Hispanic population is likely to increase the proportion of the population without health insurance. Particularly striking are differences in private health insurance coverage among the three major Hispanic groups--Cuban-Americans, Mexican-Americans, and Puerto Ricans. In this paper, regression-based decomposition analysis is used to explain the sources of differences in private health insurance coverage among working males in these three group. The results indicate that among the study population, Cuban-Americans have higher rates of private health insurance coverage than Mexican-Americans and Puerto Ricans, and that wage rates, levels of education, age, occupation, and marital status explain most of the difference.

Adult↗
PubMed1997

How expensive is unlimited mental health care coverage under managed care?

OBJECTIVES: To study costs, access, and intensity of mental health care under managed care carve-out plans with generous coverage; compare with assumptions used in policy debates; and simulate the consequences of removing coverage limits for mental health care as required by the Mental Health Parity Act. DESIGN: Claims data from 1995 and 1996 for 24 managed care carve-out plans; all plans offered unlimited mental health coverage with minimal co-payments. OUTCOME MEASURES: Probability of care, intensity of care, and total costs broken down by service type and type of enrollee. RESULTS: Assumptions used in last year's policy debate overstate actual managed care costs by a factor of 4 to 8. In the plans studied, costs are lower owing to reduced hospitalization rates, a relative shift to outpatient care, and reduced payments per service. However, access to mental health specialty care increased (7.0% of enrollees) compared with the preceding fee-for-service plans (6.5%) or free care in the RAND Health Insurance Experiment (5.0%). Removing an annual limit of $25000 for mental health care, which is the average among plans currently imposing limits, will increase insurance payments only by about $1 per enrollee per year. Children are the main beneficiaries of expanded benefits. CONCLUSIONS: Concerns about costs have stifled many health system reform proposals. However, policy decisions were often based on incorrect assumptions and outdated data that led to dramatic overestimates. For mental health care, the cost consequences of improved coverage under managed care, which by now accounts for most private insurance, are relatively minor.

Costs and Cost Analysis↗
PubMed2003

Impact of Medicare coverage on basic clinical services for previously uninsured adults.

CONTEXT: Uninsured adults receive less appropriate care and have more adverse health consequences than insured adults. Longitudinal studies would help to more clearly define the effects of health insurance on health care and health. OBJECTIVE: To assess the differential effects of gaining Medicare coverage on use of basic clinical services and medications by previously insured and uninsured adults. DESIGN AND SETTING: Household survey data from the nationally representative Health and Retirement Study were used to analyze differences in receipt of basic clinical services by adults in 1996 and 2000, before and after becoming eligible for Medicare at age 65 years. PARTICIPANTS: A total of 2203 adults aged 60 to 64 years in 1996 who were classified as continuously uninsured (n = 167), intermittently uninsured (n = 216), or continuously insured (n = 1820) in 1994 and 1996, prior to Medicare eligibility. MAIN OUTCOME MEASURES: Individuals' reports of receiving cholesterol testing, mammography (in women), prostate examination (in men), and treatment of arthritis and hypertension in the prior 2 years. RESULTS: The difference in cholesterol testing between continuously insured and continuously uninsured adults was significantly reduced after Medicare eligibility (35.4% vs 17.7%; change of -17.7% [95% CI, -29.3% to -6.2%]; P =.003), and the reduction was substantially greater among those with hypertension or diabetes than among other adults (29.2% vs 7.7%; difference of 21.5% [95% CI, 0.2% to 42.9%]; P =.048). Differences in use were similarly reduced after Medicare eligibility for mammography in women (30.3% vs 15.0%; change of -15.3% [95% CI, -29.9% to -0.7%]; P =.04) and prostate examination in men (45.2% vs 20.0%; change of -25.2% [95% CI, -45.4% to -5.1%]; P =.01). Continuously uninsured adults with arthritis reported significantly greater increases in arthritis-related medical visits and limitations of activity than continuously insured adults after Medicare eligibility, but not greater increases in arthritis treatments. Among adults with hypertension, differences in use of antihypertensive medications between continuously uninsured and insured adults were essentially unchanged after Medicare coverage. CONCLUSIONS: Previously uninsured adults substantially increased their use of covered basic clinical services but not medications after gaining Medicare coverage. An affordable option through which near-elderly uninsured adults could purchase Medicare coverage might have similar effects.

Aged↗
PubMed1998

Parvalbumin immunoreactive neurons in the rat septal complex have substantial glial coverage and receive few direct contacts from catecholaminergic terminals.

Our previous studies have demonstrated that septohippocampal neurons in the rat septal complex have substantial glial coverage and have a number of synaptic associations with catecholaminergic terminals. While similar ultrastructural characteristics are observed for septal cholinergic neurons, the morphology and synaptic relations of catecholaminergic terminals with septal GABAergic neurons is largely unknown. Since the GABAergic septohippocampal neurons colocalize the calcium-binding protein, parvalbumin (PVA), the present study examined the ultrastructural relations of PVA neurons with catecholaminergic terminals in the septal complex. Single sections were dually labeled with antibodies to PVA and either tyrosine hydroxylase (TH) or dopamine-beta-hydroxylase (DBH). By light microscopy, processes with TH- and DBH- (TH/DBH) immunoreactivity were near PVA-labeled neurons. By electron microscopy, PVA-labeled perikarya had an average diameter of 14.9+/-6 microm and were ovoid or elongated. PVA-labeled perikarya (n = 124) had a large amount of astrocytic coverage (75+/-14%) and a low amount of terminal coverage (15+/-12%). PVA-labeled perikarya and dendrites mostly were contacted by terminals lacking immunoreactivity for either PVA or TH/DBH (82% of 1,663). Of the TH/DBH terminals or axons near PVA somata and dendrites, few (3% of 1,663) directly contacted them while the majority abutted adjacent glial or neuronal profiles. Some TH/DBH- and PVA-labeled terminals contacted the same dendrites; a few of these contained immunoreactivity for PVA. The results demonstrate that PVA-containing GABAergic septal neurons, like cholinergic neurons, are mostly surrounded by astrocytes and have very little terminal coverage. However, in contrast to cholinergic neurons, PVA-containing neurons are contacted primarily by non-catecholaminergic terminals suggesting that any functional interactions would be indirect. These findings further support the functional diversity of subpopulations of septohippocampal neurons.

Animals↗
PubMed2006

Percutaneous needle aspiration, injection, and reaspiration with or without benzimidazole coverage for uncomplicated hepatic hydatid cysts.

BACKGROUND: Hepatic hydatid cyst is an important public health problem in parts of the world where dogs are used for cattle breeding. Management of uncomplicated hepatic hydatid cysts is currently surgical. However, the puncture, aspiration, injection, and re-aspiration (PAIR) method with or without benzimidazole coverage has appeared as an alternative to surgery over the past decade. OBJECTIVES: To assess the benefits and harms of PAIR with or without benzimidazole coverage for patients with uncomplicated hepatic hydatid cyst in comparison with sham/no intervention, surgery, or medical treatment. SEARCH STRATEGY: The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Controlled Trials Register in The Cochrane Library, MEDLINE, EMBASE, DARE, and ACP Journal Club and full text searches were combined (all searched October 2004). Reference lists of pertinent studies and other identified literature were scanned. Researchers in the field were contacted. SELECTION CRITERIA: Only randomised clinical trials using the PAIR method with or without benzimidazole coverage as the experimental treatment of uncomplicated hepatic hydatid cyst (ie, hepatic hydatid cysts which are not infected and do not have any communication with the biliary tree or other viscera) versus no intervention, sham puncture (ie, performing all steps for puncture, pretending that PAIR is being performed, but actually not performing the procedure proper), surgery, or chemotherapy were included. DATA COLLECTION AND ANALYSIS: Data were independently extracted and methodological quality of each trial was assessed by the authors. Principal authors of the trials were contacted to retrieve missing data. MAIN RESULTS: We found no randomised clinical trials comparing PAIR versus no or sham intervention. We identified only two randomised clinical trials, one comparing PAIR versus surgical treatment (n = 50) and the other comparing PAIR (with or without albendazole) versus albendazole alone (n = 30). Both trials were graded as 'adequate' for allocation concealment; however, generation of allocation sequence and blinding methods were 'unclear' in both of them. Compared to surgery, PAIR plus albendazole obtain similar cyst disappearance and mean cyst diameter with fewer adverse events (32% versus 84%, P < 0.001) and fewer days in hospital (mean + SD) ( 4.2 + 1.5 versus 12.7 + 6.5 days, P < 0.001). Compared to albendazole, PAIR with or without albendazole obtain significantly more often (P < 0.01) cyst reduction and symptomatic relief. AUTHORS' CONCLUSIONS: PAIR seems promising, but there is insufficient evidence to support or refute PAIR with or without benzimidazole coverage for treating patients with uncomplicated hepatic hydatid cyst. Further well-designed randomised clinical trials are necessary to address the topic.

Albendazole↗
PubMed2005

A DFT study of the adsorption and dissociation of CO on Fe(100): influence of surface coverage on the nature of accessible adsorption states.

In the present article, we report adsorption energies, structures, and vibrational frequencies of CO on Fe(100) for several adsorption states and at three surface coverages. We have performed a full analysis of the vibrational frequencies of CO, thus determining what structures are stable adsorption states and characterizing the transition-state structure for CO dissociation. We have calculated the activation energy of dissociation of CO at 0.25 ML (ML = monolayers) as well as at 0.5 ML; we have studied the dissociation at 0.5 ML to quantify the destabilization effect on the CO(alpha3) molecules when a neighboring CO molecule dissociates. In addition, it is shown that the number and nature of likely adsorption states is coverage dependent. Evidence is presented that shows that the CO molecule adsorbs on Fe(100) at fourfold hollow sites with the molecular axis tilted away from the surface normal by 51.0 degrees. The asorprton energy of the CO molecule is -2.54 eV and the C-O stretching frequency is 1156 cm(-1). This adsorption state corresponds to the alpha3 molecular desorption state reported in temperature programmed desorption (TPD) experiments. However, the activation energy of dissociation of CO(alpha3) molecules at 0.25 ML is only 1.11 eV (approximately 25.60 kcal mol(-1)) and the gain in energy is -1.17 eV; thus, the dissociation of CO is largely favored at low coverages. The activation energy of dissociation of CO at 0.5 ML is 1.18 eV (approximately 27.21 kcal mol(-1)), very similar to that calculated at 0.25 ML. However, the dissociation reaction at 0.5 ML is slightly endothermic, with a total change in energy of 0.10 eV Consequently, molecular adsorption is stabilized with respect to CO dissociation when the CO coverage is increased from 0.25 to 0.5 ML.

Journal Article↗
PubMed2006

Toward high sequence coverage of proteins in human breast cancer cells using on-line monolith-based HPLC-ESI-TOF MS compared to CE MS.

A method is developed toward high sequence coverage of proteins isolated from human breast cancer MCF10 cell lines using a 2-D liquid separations. Monolithic-capillary columns prepared by copolymerizing styrene with divinylbenzene are used to achieve high-resolution separation of peptides from protein digests. This separation is performed with minimal sample preparation directly from the 2-D liquid fractionation of the cell lysate. The monolithic column separation is directly interfaced to ESI-TOF MS to obtain a peptide map. The protein digests were also analyzed by MALDI-TOF MS and an accurate M(r) of the intact protein was obtained using an HPLC-ESI-TOF MS. The result is that these techniques provide complementary information where nearly complete sequence coverage of the protein is obtained and can be compared to the experimental M(r) value. The high sequence coverage provides information on isoforms and other post-translational modifications that would not be available from methods that result in low sequence coverage. The results from the use of monolithic columns are compared to that obtained by CE-MS. The monolithic column separations provide a rugged and highly reproducible method for separating protein digests prior to MS analysis and is suited to confidently identify biomarkers associated with cancer progression.

Amino Acid Sequence↗
PubMed1997

[Vaccination coverage in young children and school children in the Bern canton].

In 1995 immunization coverage at 24 months of age and after the first school year was estimated according to the method recommended by the WHO. Vaccination booklets of 840 children born in 1986, 1987, 1988 or 1991 in the Canton of Berne were reviewed. The response rate was high (96%). The immunization coverage at 24 months of age were for measles 74%, for mumps and rubella (MMR) 72% higher than for diphteria (D), tetanus (T) (62%) and poliomyelitis (polio) (60%) (4 doses) (p < 0.0001). Of the Swiss children born in 1991 32% were vaccinated against tuberculosis. Children 24 months of age of all years had generally a similar immunization coverage. The 101 children of foreign nationalities showed somewhat lower vaccination rates. Immunization uptake for MMR, DT and polio (4 doses) increased over time, so that children born in 1986 at 8.5 years of age had the rate (> 95%) to be reached at the end of the second year of life. After the first school year 88% of the 8.5 years old children presented a vaccination against MMR and 91% a vaccination against measles. Intensified efforts are necessary to achieve a higher immunization coverage at 24 months of age especially among children of foreign nationality, a timely administration of vaccines according to recommended immunization schedule and to restrict BCG vaccine to children at increased risk of tuberculosis.

Child↗
PubMedDate not supplied

Evaluation of pulse polio and routine immunisation coverage: Alwar District, Rajasthan.

During the last decade, India achieved 88% reduction in reported poliomyelitis incidence. However, absolute number of reported cases still remains high. As an added effort to eradicate the disease, the country observed its first National Immunisation Days (NIDs) on 9.12.95 and 20.1.96. The present study evaluates the performance of Alwar district, Rajasthan. Modified 30 cluster technique was used to collect information. Overall coverage in rural and urban areas was 89% and 91% respectively. Main source of information was television in urban and health staff in rural areas. Most of the respondents knew about the usefulness of such special activity and had favourable opinion about the facilities provided. Urban Alwar had 80% OPV3 coverage but, in rural area it was almost half. The reported coverage of NIDs and UIP was found to be conflicting with the study results. The existing "dose enumeration method" of calculating reported coverage was attributed to be the cause. The study emphasises the need to incorporate an in-built community-based evaluation of future NIDs and utilisation of such results for planning.

Child, Preschool↗