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PubMed2002

Using Medicaid/SCHIP to insure working families: the Massachusetts experience.

Massachusetts was the first State to implement a premium subsidy program for employer-sponsored health insurance, using both Medicaid and State Children's Health Insurance Program (SCHIP) funding. The Insurance Partnership (IP) provides subsidies directly to small employers, and the Premium Assistance Program provides subsidies to their low-income employees. Approximately 3,500 small firms currently participate, most of them offering health insurance coverage for the first time. Approximately 10,000 adults and children are covered through the program, the majority of whom had been uninsured prior to enrolling. Massachusetts' successful experience with premium subsidies offers important lessons for other States wishing to implement similar programs.

Child↗
PubMed2006

Satisfaction with care and ease of using health care services among parents of children with special health care needs: the roles of race/ethnicity, insurance, language, and adequacy of family-centered care.

OBJECTIVES: To examine whether racial/ethnic disparities exist in parental reports of satisfaction with care and ease of using health care services among children with special health care needs (CSHCN) and to identify factors associated independently with satisfaction with care and ease of use of health care services among CSHCN. METHODS: We analyzed data for 38,886 CSHCN <18 years of age in the National Survey of CSHCN, conducted from 2000 to 2002. Outcome variables included perceived satisfaction with care and ease of service use. Covariates included sociodemographic factors, insurance, interview language, condition severity and stability, adequacy of family-centered care measures, and having a personal doctor/nurse. RESULTS: The prevalences of reported dissatisfaction with care and problems with ease of using services among parents of CSHCN were 8% and 25%, respectively. Black and Hispanic parents were significantly more likely than white parents to be dissatisfied with care (13% and 16% vs 7%) and to report problems with ease of service use (35% and 34% vs 23%). Hispanic/white disparities in satisfaction with care and ease of use of services disappeared only after multivariate adjustment for parental interview language. Black/white disparities in satisfaction with care disappeared after adjustments for adequacy of family-centered care measures, but black/white disparities in ease of using services persisted. The severity of the child's condition, lack of insurance, parental interview in Spanish, and inadequate family-centered care were associated significantly with dissatisfaction with care and problems with ease of using health care services. CONCLUSIONS: Policies and strategies that reduce language barriers, promote insurance coverage and family-centered care, and improve ease of use of services among minority CSHCN have the potential to reduce racial/ethnic disparities in satisfaction with care and to promote ease of use of services among families with CSHCN.

Attitude↗
PubMed2003

Disparities in adolescent health and health care: does socioeconomic status matter?

DATA COLLECTION/EXTRACTION METHODS: National household survey. DATA SOURCES/STUDY SETTING: We analyzed data on 12,434 adolescents (10 through 18 years old) included in the 1999 and 2000 editions of the National Health Interview Survey. STUDY DESIGN: We assessed the presence of income gradients using four income groups. Outcome variables included health status, health insurance coverage, access to and satisfaction with care, utilization, and unmet health needs. PRINCIPAL FINDINGS: After adjustment for confounding variables using multivariate analysis, statistically significant disparities were found between poor adolescents and their counterparts in middle- and higher-income families for three of four health status measures, six of eight measures of access to and satisfaction with care, and for six of nine indicators of access to and use of medical care, dental care, and mental health care. CONCLUSION: Our analyses indicate adolescents in low-income families remain at a disadvantage despite expansions of the Medicaid program and the comparatively new State Children's Health Insurance Program (SCHIP). Additional efforts are needed to ensure eligible adolescents are enrolled in these programs. Nonfinancial barriers to care must also be addressed to reduce inequities.

Adolescent↗
PubMedDate not supplied

Challenges of state health reform: variations in ten states.

This DataWatch reports on the key findings from the 1993 Robert Wood Johnson Foundation Family Health Insurance Survey, which interviewed more than 27,000 families in ten states. There is considerable variation among the states in insurance coverage, health status, and access to care of both adults and children. Moreover, states with higher percentages of uninsured residents also have populations with lower health status and more access problems. This clustering of problems in certain states may make health care reform even more challenging for their elected officials to accomplish.

Adult↗
PubMedDate not supplied

Evidence-based medicine and policy: the case of the implantable cardioverter defibrillator.

The implantable cardioverter defibrillator (ICD) is a costly new treatment for patients at high risk of sudden cardiac death. Randomized trials of the ICD showed it to be effective in some groups of patients but not in others. While new trials testing the ICD were ongoing to clarify the evidence, policymakers faced immediate decisions about providing insurance coverage for the device. The high cost of ICDs, the large population of patients potentially eligible to receive them, the potential to reduce preventable deaths, and the unsettled state of the medical evidence provided a challenge to evidence-based medicine and to policymakers.

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

BC appellate court dismisses insurance appeal.

As reported in the last issue of the Newsletter, in September 1997 a British Columbia trial court had dismissed a "wrongful dismissal" claim by the estate of a gay man who died of AIDS against his former employer for damages arising out of his termination, including the loss of his life insurance coverage. The man's estate appealed that decision to the BC Court of Appeal. The Canadian AIDS Society and the BC Persons with AIDS Society were denied leave to intervene before the appellate court to make submissions. The case was heard in October 1999 by the British Columbia Court of Appeal. In December 1999, the Court released its judgment dismissing the appeal.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Patient satisfaction with LASIK surgery in New York State.

The purpose of this paper is to provide a descriptive analysis of patients who have recently undergone laser-assisted in situ keratomileusis (LASIK) surgery in New York State and record the level of patient satisfaction with perceived visual outcome. A survey was mailed to 230 members of a vision care benefits plan. The questionnaire focused on five specific areas: (I) motivation, (2) satisfaction, (3) functional outcome, (4) postsurgical experience, and (5) out-of-pocket expenditures. Patients were at least three months postsurgery and had undergone surgery between September 2002 and August 2003. One hundred sixty-five (72%) surveys were received. An average overall "experience" score of 8.9 out of 10 ten was recorded. Average out-of-pocket expenses exceeded 1600 dollars despite an insurance coverage of 200 dollars per eye plus a 25% discount for using network ophthalmic surgeons. With growing competition among physicians performing LASIK surgery, the effort to find more patients intensifies. However, as the majority of those surveyed selected their surgeon based on reputation or referral, it is essential that physicians be vigilant in choosing their cases and cognizant of the importance of patient satisfaction.

Humans↗
PubMedDate not supplied

Reproductive health services for adolescents under the State Children's Health Insurance Program.

CONTEXT: The federal government enacted the State Children's Health Insurance Program (CHIP) in 1997 to provide insurance coverage to uninsured, low-income children up to age 19. Individual states' decisions when designing their CHIP efforts will in large part determine the extent to which the program will help the nation's nearly three million low-income uninsured adolescents get needed reproductive health services. METHODS: CHIP administrators in all states and the District of Columbia were sent a survey concerning reproductive health services for adolescents aged 13-18 provided under their state's CHIP effort. The questionnaire asked about services covered, information provided to adolescents, confidentiality, outreach and enrollment activities, managed care and performance measures. RESULTS: Of the 46 respondents to the survey, 29 states and the District of Columbia included a Medicaid component to their CHIP effort, and 28 states included a state-designed component. Overall, states provided relatively comprehensive coverage of reproductive health services, with all 58 CHIP programs covering routine gynecologic care, screening for sexually transmitted diseases and pregnancy testing. Fifty-four covered the full range of the most commonly used prescription contraceptive methods, although only 43 covered emergency contraception. Twenty of 58 CHIP programs required that adolescents be provided with information about coverage for the full range of reproductive health services, and 18 required that information be provided about accessing care. Seventeen programs reported guarantees of confidentiality before and after receipt of reproductive health care. In 26 programs, enrollees in managed care were guaranteed access to contraceptive services through out-of-network providers. Twenty-six states and the District of Columbia reported targeting outreach activities specifically to adolescents, and 41 states and the District of Columbia stated that they provide outreach materials at middle schools, high schools and community-based organizations serving teenagers. CONCLUSIONS: Despite their nearly comprehensive coverage of reproductive health services, programs were inconsistent in guaranteeing the information, confidentiality and flexibility in choosing providers that is critical to adolescents' ability to access care. In addition, many states failed to creatively use strategies to target uninsured adolescents for enrollment, although new initiatives are under way to correct this problem.

Adolescent↗
PubMed2000

Assessing SCHIP effects using household survey data: promises and pitfalls.

OBJECTIVES: To describe how household surveys can be used to assess the effects of the new State Children's Health insurance Program (SCHIP) , review methodologic issues associated with household survey data, and propose solutions for dealing with these issues. PRINCIPAL FINDINGS: To estimate the effect of SCHIP, analysis must explicitly recognize and control for the fact that other factors that could affect the outcomes of interest besides the new program will change over the analysis period. In assessing SCHIP's effect, SCHIP-eligible children must be identified using a detailed simulation model. Analyses that use either a simple eligibility model or only examine children with incomes between 100 and 200 percent of poverty will not accurately identify SCHIP-eligible children. Under these circumstances estimates of the effect of SCHIP will be biased downward. In addition analyses must rely on the same survey in the pre- and post- SCHIP periods to obtain reliable estimates. Moreover, the survey must attempt to obtain data on separate SCHIP programs, and analysts must consider the implications of the possible increasing underreporting of public health insurance coverage. Finally, analysts should be cautious about evaluating SCHIP's success before the program is mature. CONCLUSION: While evaluating SCHIP using household surveys has some challenges, if conducted carefully such analyses will provide important in formation on the effect of the SCHIP program that can not be obtained elsewhere.

Child↗
PubMed2005

Do employers voluntarily include patient protections in self-insured managed care plans?

Managed care patient protection laws passed by states do not apply to health plans sponsored by self-insured employers, although 54% of workers who receive health insurance coverage through their employer are in self-insured plans. In-depth interviews conducted in five states with employers offering self-insured health benefits and with other knowledgeable market informants provide evidence that self-insured managed care plans nonetheless include important features that strengthen subscribers' access to medical providers. Less common in these plans were features providing for independent external appeal of coverage denials and for protecting network providers from undue influence by plan administrators.

Employee Retirement Income Security Act↗
PubMed1998

Ability to pay and the decision to medicate.

OBJECTIVES: It is widely recognized that ability to pay affects access to hospital and physician services. Much less is known about the economic determinants of prescription drug use, particularly among the elderly. The authors hypothesize that persons with higher incomes and better health insurance coverage are more likely to medicate common health problems than those with lower incomes and less comprehensive coverage. METHODS: A random sample of 4,066 elderly Pennsylvania Medicare beneficiaries were asked to complete a mail survey on health insurance, income, and medicine use for 23 common health problems. The relationship between ability to pay and medication decisions was analyzed using logistic and Poisson regression models with covariates for sociodemographic characteristics and health status. RESULTS: A strong and consistent relationship was found in the hypothesized direction. Other things being equal, elderly persons with Medicare supplementation were between 6% and 17% more likely to use prescription medicine to treat their health problems than are persons with Medicare coverage alone. The presence of prescription drug coverage significantly increased the odds of prescription treatment for 10 of the 22 conditions examined. The insurance effects were generally--but not exclusively--more pronounced for less serious compared with serious health problems. Income also was shown to have a strong independent effect on medication decisions. Elderly with annual incomes greater than $18,000 were 18% more likely to treat problems with prescription drugs than were persons with annual incomes less than $6,000. CONCLUSIONS: In sum, economic factors appeared to play an important role in medication decisions by the elderly. The magnitude of the impact was sufficiently high that it could have major negative consequences on the health of elderly persons who are poor and lack drug coverage.

Aged↗
PubMed2003

Moving beyond poverty: neighborhood structure, social processes, and health.

We investigate the impact of neighborhood structural characteristics, social organization, and culture on self-rated health in a large, cross-sectional sample of urban adults. Findings indicate that neighborhood affluence is a more powerful predictor of health status than poverty, above and beyond individual demographic background, socioeconomic status, health behaviors, and insurance coverage. Moreover, neighborhood affluence and residential stability interact in their association with health. When the prevalence of affluence is low, residential stability is negatively associated with health. Neighborhood affluence also accounts for a substantial proportion of the racial gap in health status. Finally, collective efficacy is a significant positive predictor of health but does not mediate the effects of structural factors.

Adult↗
PubMedDate not supplied

Physicians' early challenges related to the pneumococcal conjugate vaccine.

OBJECTIVE: To characterize the obstacles faced by physicians regarding administration of a 7-valent pneumococcal conjugate vaccine (Prevnar) to all children younger than 2 years and to high-risk children from 2--5 years of age during the months immediately following national recommendations. DESIGN: Semistructured telephone interviews. PARTICIPANTS: Convenience sample (n = 24) of pediatricians and family physicians. RESULTS: Eighteen physicians were recommending pneumococcal vaccine and 6 were not. Those who were recommending pneumococcal vaccine had encountered resistance from parents and variations in private and public insurance coverage. Physicians who were not recommending pneumococcal vaccine expressed concern about the cost of the vaccine and general caution in adopting new vaccine recommendations. Respondents offered several suggestions for improving the vaccine recommendation process. CONCLUSIONS: This analysis of physicians' early decision making regarding pneumococcal vaccine reflects obstacles to vaccine implementation that may arise with the introduction of other childhood vaccines.

Adult↗
PubMed1999

MCOs--you're using the wrong benefits!

If managed care organizations (MCOs) think of the benefits they offer and deliver in terms of narrow insurance coverage and limited payments for carefully circumscribed lists of health services, they miss the boat in marketing to consumers. Only by identifying, promising, delivering, and ensuring that consumers perceive core psychological benefits--a sense of security against catastrophic illness, assurance of access to necessary care, and the positive impacts on quality of life that health care can create--will MCOs realize the full potential of the real benefits consumers are after.

Advertising↗
PubMedDate not supplied

Emerging trends in mental health policy and practice.

The continuing deinstitutionalization of patients in public mental hospitals and the growth of managed care are fundamentally altering mental health practice. Managed care provides opportunities for achieving parity of insurance coverage between mental and physical illness, but serious problems persist in integrating mental health, substance abuse, and general medical care and assuring an appropriate range of services and programs for persons with serious mental illness residing in community settings. Hospital and community care are poorly coordinated, and hospital care needs to be integrated into a more balanced system of services. Important new roles are emerging for purchasers, patient advocates, and mental health authorities.

Comprehensive Health Care↗
PubMed2004

A population-based study of colorectal cancer test use: results from the 2001 California Health Interview Survey.

BACKGROUND: Recent research has supported the use of colorectal cancer (CRC) tests to reduce disease incidence, morbidity, and mortality. A new health survey has provided an opportunity to examine the use of these tests in California's ethnically diverse population. The authors used the 2001 California Health Interview Survey (CHIS 2001) to evaluate 1) rates of CRC test use, 2) predictors of the receipt of tests, and 3) reasons for nonuse of CRC tests. METHODS: The CHIS 2001 is a random-digit dial telephone survey that was conducted in California. Responses were analyzed from 22,343 adults age >/= 50 years. CRC test use was defined as receipt of a fecal occult blood test in the past year and/or receipt of an endoscopic examination in the past 5 years. RESULTS: Nearly 54% of California adults reported receipt of a recent CRC test. Insurance coverage and having a usual source of care were the most important predictors of CRC testing. Latinos age < 65 years were less likely to be tested than whites (relative risk [RR], 0.84; 95% confidence interval [95% CI], 0.77-0.92). Men were more likely to be tested than women, an effect that was greater among individuals age 50-64 years (RR, 1.28; 95% CI, 1.23-1.32) than among individuals age >/= 65 years (RR, 1.19; 95% CI, 1.15-1.23). Women were more likely than men to say that their physician did not inform them the test was needed and that CRC tests were painful or embarrassing. CONCLUSIONS: Results of the current study indicate a need for physicians to recommend CRC testing to their patients. Assuring that all individuals have both health insurance and a usual source of care would help address gaps in the receipt of CRC tests.

Aged↗
PubMed2001

Targeting risk for unmet need: not enough help versus no help at all.

OBJECTIVES: This study examined factors associated with unmet need for care among persons aged 18 and older who need help with daily living tasks. The analysis focused on two types of unmet need: not enough (or inadequate) help and no help at all. METHODS: The authors used multinomial logistic regression to examine differences between persons with long-term care needs who (a) had all their needs met; (b) received inadequate help; and (c) received no help at all. Data were from the Adult Followback to the National Health Interview Survey on Disability (NHIS-D) for 1994 and 1995. RESULTS: The determinants of inadequate care versus no care differed with respect to age, gender, level of impairment, and insurance status. Whereas age and gender were important in determining inadequate care, insurance coverage and availability of social support were key factors related to a situation of no care. DISCUSSION: The present study demonstrates that the characteristics of groups reporting inadequate care versus no care, and the factors associated with these situations, are quite different. Nevertheless, the most important demographic risk factors for both types of unmet need mirror demographic groups currently on the increase in the U.S. population.

Activities of Daily Living↗