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PubMed2003

Favorable patient acceptance of ambulatory blood pressure monitoring in a primary care setting in the United States: a cross-sectional survey.

BACKGROUND: The use of ambulatory blood pressure monitoring (ABPM) in the diagnosis and management of hypertension in primary care settings in the United States is increasing. Insufficient information is available describing patients' experiences and acceptance of this technology in the United States, where medical insurance coverage of the procedure is often limited. The objective of this study was to describe patient satisfaction with ABPM performed in a primary care office in the United States, using modern ABPM technology. METHODS: Cross-sectional survey performed on consecutive patients referred to the ABPM service of the Family Care Center, University of Iowa Hospitals and Clinics, Iowa City, Iowa from January 2001 to July 2003. Measures of patient satisfaction and acceptance with the device, comfort, and overall session were assessed via a 9-question, Likert-scale response survey. RESULTS: Since its inception two and a half years ago, 245 total ABPM sessions have been conducted in 235 unique patients. Of the 235 eligible respondents, 177 returned completed surveys, yielding a 75% response rate. Three-fourths (75%) of patients believed that undergoing the test was worthwhile considering the time and monetary cost involved, while most (90%) reported they thought the information provided by the test would be helpful to their physician in making treatment decisions. Patients reporting that their physician had clearly explained the benefit of undergoing the testing were more likely to report that they thought the results of the test would be more helpful in making treatment decisions. Few patients (20%) found that wearing the monitor was uncomfortable. CONCLUSIONS: When clinically indicated, clinicians should not hesitate to order ABPM testing for fear of subjecting patients to an uncomfortable test, or an uncovered insurance benefit. When ordering ABPM, they should be sure to educate the patient about the potential benefits of undergoing the testing. Most patients believe the test will provide useful information in making treatment decisions, despite probable lack of insurance coverage, and appear willing to experience some discomfort for the overall gain of the results obtained from undergoing the session.

Adolescent↗
PubMed2000

Type of health insurance and the quality of primary care experience.

OBJECTIVES: This study examined the association between type of health insurance coverage and quality of primary care as measured by its distinguishing attributes--first contact, longitudinality, comprehensiveness, and coordination. METHODS: The household component of the 1996 Medical Expenditure Panel Survey was used for this study. The analysis primarily focused on subjects aged younger than 65 years who identified a usual source of care. Logistic regressions were used to examine the independent effects of insurance status on primary care attributes while individual sociodemographic characteristics were controlled for. RESULTS: The experience of primary care varies according to insurance status. The insured are able to obtain better primary care than the uninsured, and the privately insured are able to obtain better primary care than the publicly insured. Those insured through fee-for-service coverage experience better longitudinal care and less of a barrier to access than those insured through health maintenance organizations (HMOs). CONCLUSIONS: While expanding insurance coverage is important for establishing access to care, efforts are needed to enhance the quality of primary health care, particularly for the publicly insured. Policymakers should closely monitor the quality of primary care provided by HMOs.

Adolescent↗
PubMed2005

Persistent demographic differences in colorectal cancer screening utilization despite Medicare reimbursement.

BACKGROUND: Colorectal cancer screening is widely recommended, but often under-utilized. In addition, significant demographic differences in screening utilization exist. Insurance coverage may be one factor influencing utilization of colorectal cancer screening tests. METHODS: We conducted a retrospective analysis of claims for outpatient services for Washington state Medicare beneficiaries in calendar year 2000. We determined the proportion of beneficiaries utilizing screening fecal occult blood tests, flexible sigmoidoscopy, colonoscopy, or double contrast barium enema in the overall population and various demographic subgroups. Multiple logistic regression analysis was used to determine the relative odds of screening in different demographic groups. RESULTS: Approximately 9.2% of beneficiaries had fecal occult blood tests, 7.2% had any colonoscopy, flexible sigmoidoscopy, or barium enema (invasive) colon tests, and 3.5% had invasive tests for screening indications. Colonoscopy accounted for 41% of all invasive tests for screening indications. Women were more likely to receive fecal occult blood test screening (OR 1.18; 95%CI 1.15, 1.21) and less likely to receive invasive tests for screening indications than men (OR 0.80, 95%CI 0.77, 0.83). Whites were more likely than other racial groups to receive any type of screening. Rural residents were more likely than urban residents to have fecal occult blood tests (OR 1.20, 95%CI 1.17, 1.23) but less likely to receive invasive tests for screening indications (OR 0.89; 95%CI 0.85, 0.93). CONCLUSION: Reported use of fecal occult blood testing remains modest. Overall use of the more invasive tests for screening indications remains essentially unchanged, but there has been a shift toward increased use of screening colonoscopy. Significant demographic differences in screening utilization persist despite consistent insurance coverage.

Age Distribution↗
PubMed1997

The transplant trap: the impact of health policy on employment status following renal transplantation.

This study examined the relationship between concern for health insurance coverage and employment status following renal transplantation. The sample consisted of 293 individuals who underwent renal transplantation at The Ohio State University Medical Center. The study found fewer individuals reported employment during the past year (58%) than indicated they were able to work (72%). Although 72% of the sample indicated the physical ability to work 41% reported receiving a monthly disability check. Regression analysis revealed that receipt of a monthly disability check and employment status one day prior to transplant were the two most significant predictor variables for employment activity during the year prior to participation in this study. Intervention that is coordinated on a psychosocial level from the time of diagnosis of ESRD throughout the post-transplant period is critical to supporting individuals in pursuing their goals. Research findings should be utilized to advise policy-makers and advocate for system changes that support employment for individuals with ESRD.

Adolescent↗
PubMed2006

Unstable inferences? An examination of complex survey sample design adjustments using the Current Population Survey for health services research.

Statistical analysis of the Current Population Survey's Annual Social and Economic Supplement is used widely in health services research. However, the statistical evidence cited from the Current Population Survey (CPS) is not always consistent because researchers use a variety of methods to produce standard errors that are fundamental to significance tests. This analysis examines the 2002 Annual Social and Economic Supplement's (ASEC) estimates of national and state average income, national and state poverty rates, and national and state health insurance coverage rates. Findings show that the standard error estimates derived from the public use CPS data perform poorly compared with the survey design-based estimates derived from restricted internal data, and that the generalized variance parameters currently used by the U.S. Census Bureau in its ASEC reports and funding formula inputs perform erratically. Because the majority of published research (both by academics and Census Bureau analysts) does not make use of the survey design-based information available only on the internal ASEC data file, we argue that the Census Bureau ought to use alternative methods for its official ASEC reports. We also argue that for public use data the Census Bureau should produce a set of replicate weights for the ASEC or release a set of sample design variables that incorporate statistical "noise" to maintain respondent confidentiality (e.g., pseudo-primary sampling units) as other federal government surveys do. This is essential to make appropriate inferences using the ASEC data regarding statistical significance and estimate variance for health policy analysis.

Censuses↗
PubMed1997

The socioeconomic profile of patients treated by phlebotropic drugs in Germany.

Conservative treatment of venous disease is difficult. There is much skepticism concerning the efficacy of drugs in venous diseases. Nevertheless, in Germany, these drugs have obtained a substantial market share with a tendency to increase. The objective of this empirical study is to evaluate the socioeconomic characteristics of consumers of venous medications and to explore the demand elasticity with respect to health insurance coverage. In a first set of inquiries 12,500 households were asked from July to September 1993 if they had purchased prescribed venous medication during the past 12 months. About 10,000 households with 19,750 persons aged fifteen years and older responded; 2,080 (11%) of those persons had consumed prescribed medications against venous disease over the past twelve months. In the second part of the study a detailed questionnaire was sent to the 2,080 purchasers and to 3,000 randomly selected nonpurchasers; 1,930 (92.8%) purchasers and 2,291 (76.4%) nonpurchasers returned their questionnaire. The key findings can be summarized as follows: The percentage of women is much higher in the group of purchasers (80%) than in the group of nonpurchasers. Most of the purchasers are over fifty years old. Only one quarter of the purchasers are under fifty. One third of the purchasers are retired, and only 29% are working. In the group of nonpurchasers 56% are working and only 17% are retired. A comparison of the distribution of purchasers and nonpurchasers over income classes and education levels shows that higher income and higher education are less prevalent in the group of consumers of venous medications. Varicose veins (58%) and various leg complications (30%) and pain in the legs (30%) play a dominant role for applying venous medications. The analysis shows that pregnancy and chronic diseases are risk factors for venous disease and are more prevalent in the purchasers group. We did not, however, discover a significant difference in the share of smokers, and it is quite low in the group of purchasers (14%). Only 45% of the purchasers feel that their venous disease has a negative influence on their spare-time activities, their family life, or their work. Purchasers consult a physician on the average 3.7 times a year; 40% of the managers, merchants, and self-employed craftsmen have no physician consultation at all. Owing to the pain and trouble of some complications of venous disease, only a relatively low percentage of purchasers would react to a reduction of health insurance coverage of venous medications; 5% would stop buying these drugs and 22% would reduce consumption if they would have to pay the cost out-of-pocket.

Adolescent↗
PubMed2005

Employer health insurance offerings and employee enrollment decisions.

OBJECTIVE: To determine how the characteristics of the health benefits offered by employers affect worker insurance coverage decisions. DATA SOURCES: The 1996-1997 and the 1998-1999 rounds of the nationally representative Community Tracking Study Household Survey. STUDY DESIGN: We use multinomial logistic regression to analyze the choice between own-employer coverage, alternative source coverage, and no coverage among employees offered health insurance by their employer. The key explanatory variables are the types of health plans offered and the net premium offered. The models include controls for personal, health plan, and job characteristics. PRINCIPAL FINDINGS: When an employer offers only a health maintenance organization married employees are more likely to decline coverage from their employer and take-up another offer (odds ratio (OR)=1.27, p<.001), while singles are more likely to accept the coverage offered by their employer and less likely to be uninsured (OR=0.650, p<.001). Higher net premiums increase the odds of declining the coverage offered by an employer and remaining uninsured for both married (OR=1.023, p<.01) and single (OR=1.035, p<.001) workers. CONCLUSIONS: The type of health plan coverage an employer offers affects whether its employees take-up insurance, but has a smaller effect on overall coverage rates for workers and their families because of the availability of alternative sources of coverage. Relative to offering only a non-HMO plan, employers offering only an HMO may reduce take-up among those with alternative sources of coverage, but increase take-up among those who would otherwise go uninsured. By modeling the possibility of take-up through the health insurance offers from the employer of the spouse, the decline in coverage rates from higher net premiums is less than previous estimates.

Adolescent↗
PubMedDate not supplied

SCHIP making progress: increased take-up contributes to coverage gains.

Previous research based on the Community Tracking Study (CTS) showed that while coverage expansions through the State Children's Health Insurance Program (SCHIP) greatly increased children's eligibility for public or private health insurance coverage, uninsurance rates remained unchanged because of low take-up by eligible children. However, more recent data show that this is changing. Children's uninsurance rates decreased sharply between 1999 and 2001; these changes were greatest in communities where take-up rates have traditionally been the lowest and uninsurance rates the highest. Although uninsurance rates still can be decreased further, state budget pressures threaten the momentum toward higher participation in public programs.

Child↗
PubMedDate not supplied

Health insurance for Hispanic and other children: access to care.

National surveys demonstrate an increased proportion of children with health insurance coverage. Much of this rise is a reflection of increases in public insurance arrangements. Nevertheless, in the early 2000s, millions of children, particularly Hispanic children, continued to lack health insurance. There were marked differences in coverage rates between different Hispanic subgroups, with 34% of Mexican American children, compared to 10% of Cuban American children, lacking insurance. The purpose of this case report was to show that the absence of insurance coverage is associated with limited access to care.

Adolescent↗
PubMed2006

Determinants of hospital loss in Thailand: experience from the first year of a universal coverage health insurance program.

The objective of this study was to examine determinants of hospital loss in Thailand. Administration national data for 640 public hospitals of fiscal year 2002 from Ministry of Public Health were analyzed. Results showed that various managerial, service mix, and market variables were significantly associated with the likelihood of the hospital being unprofitable. Hospital characteristics were associated with the amount of loss. The results also suggested that managing the number of hospital employees, inventory, and patient hospitalization could control the amount of loss. In conclusion, most of identified factors associated with hospital loss were manageable. The ramification of this study was to help policy makers understand the hospital loss situation in Thailand after implementing the UC scheme and design policy to resolve the hospital loss problems.

Data Collection↗
PubMed2002

Depressive disorders and alcohol dependence in a community population.

This cross-sectional study examines sociodemographic, clinical and func tional correlates of comorbid depression in a community sample of 268 individuals with alcohol dependence. Results of analyses comparing drinkers with either current or past depression to never-depressed drinkers showed that respondents in the former two groups were more likely to be female and report more comorbid drug use disorders. In addition to marked functional impairment for currently depressed drinkers, we also found that respondents with past depression were significantly less likely to have health insurance coverage. This lack of insurance for previously depressed persons calls for future work examining the potential influence of this barrier to access care on both clinical and functional outcomes.

Alcoholism↗
PubMedDate not supplied

The North American Menopause Society 1998 menopause survey: Part II. Counseling about hormone replacement therapy: association with socioeconomic status and access to medical care.

OBJECTIVE: The purpose of this study was to examine two predictors of women's obtaining hormone replacement therapy (HRT) counseling: socioeconomic status and access to health care. DESIGN: During May-July 1998, by means of random-digit telephone dialing, 749 postmenopausal women who were living in the United States and aged 50-65 years were interviewed. On average, they were 56.8 years and 11.8 years postmenopausal. Most (86.0%) were Caucasian, and their median annual income was approximately $40,000. Nearly all (90.8%) had medical insurance coverage; 47.6% of those insured received care from a managed care organization. Access to medical care was evidenced by 92.3% being under the care of a primary care physician, 92.3% ever having had a mammogram, 96.9% ever having had a pelvic examination, and 91.1% ever having had a serum cholesterol determination. RESULTS: Of these 749 women, 75.4% reported that they had received counseling about post-menopausal HRT from healthcare providers. Both level of education and level of income were associated with an increased likelihood that HRT counseling would be obtained. Having a personal physician, and particularly receiving care from a gynecologist, increased the likelihood that counseling would be available. There were no substantial differences in counseling frequency between women in managed care plans and those having other types of health insurance. In a multivariate model, adjusted odds ratios for receiving HRT counseling were 2.9 (95% confidence interval [CI] = 1.7-4.8) for having an annual income of $50,000 or more versus less than $30,000, 2.8 (95% CI = 1.7-4.5) for receiving care from a gynecologist versus other primary care physician, 1.9 (95% CI = 1.1-3.2) for being Caucasian versus not, and 1.5 (95% CI 1.0-2.2) for having a hysterectomy versus not. CONCLUSIONS: Three quarters of a sample of US postmenopausal women aged 50-65 years reported that they had been counseled about HRT. However, women of lowest socioeconomic status and those who did not have a primary care physician were least likely to have received counseling. No differences were observed in prevalence of counseling between women in managed care settings and those with other types of health insurance. The findings suggest that special efforts are necessary to provide menopause education and counseling to underserved women.

Counseling↗
PubMed2006

Health care for older persons in Switzerland: a country profile.

Switzerland has the second-most-expensive healthcare system worldwide, with 11.5% of gross domestic product spent on health care in 2003. Switzerland has a healthcare system with universal insurance coverage and a social insurance system, ensuring an adequate financial situation for 96% of the 1.1 million older inhabitants. Key concerns related to the care of older persons are topics such as increasing healthcare costs, growing public awareness of patient autonomy, and challenges related to assisted suicide. In 2004, the Swiss Academy of Medical Sciences issued guidelines for the care of disabled older persons. Since 2000, geriatrics has been a board-certified discipline with a 3-year training program in addition to 5 years of training in internal or family medicine. There are approximately 125 certified geriatricians in Switzerland, working primarily in geriatric centers in urban areas. Switzerland has an excellent research environment, ranking second of all countries worldwide in life sciences research-but only 13th in aging research. This is in part due to a lack of specific training programs promoting research on aging and inadequate funding. In addition, there is a shortage of academic geriatricians in Switzerland, in part due to the fact that two of five Swiss universities had no academic geriatric departments in 2005. With more-adequate financial resources for academic geriatrics, Switzerland would have the opportunity to contribute more to aging research internationally and to improved care for older patients.

Aged↗
PubMedDate not supplied

Devolution of power: an interim report card.

During the mid-1990s liberals hoped that states would enact health insurance expansions, while conservatives looked to the states to contain costs. This essay considers whether states are meeting these great expectations. I review state performance in four policy priorities: encouraging Medicaid clients to enroll in managed care; expanding insurance coverage for children; making insurance more available and more affordable for the small-business community; and containing long-term care costs. The review suggests that states cannot accomplish these tasks without federal help. Congress seems to be getting the message and has enacted its own child health and insurance reform legislation. This trend is overdue and welcome.

Child↗
PubMed1990

Medicaid and third-party liability: using information to achieve program goals.

With Medicaid programs in most States coming under ever-increasing fiscal pressures, the issue of third-party liability is receiving more attention and scrutiny. A relatively small investment in determining health insurance coverage can yield significant savings. In New York State's program, counties are compared and ranked to give a view of how well they are succeeding in identifying eligibles with third-party coverage. In addition, health insurance premiums are analyzed to determine if policies are cost effective. Other jurisdictions may benefit from this approach to program evaluation and enhancement.

Adolescent↗