Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Medical Indigency”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 145 records · Page 8Linked to original sources
PubMed1994

Insurance coverage of patients with breast cancer in the 1991 commission on cancer patient care evaluation study.

BACKGROUND: Trends in the care of patients with cancer are monitored annually by the Commission on Cancer of the American College of Surgeons. In 1991 a patient care evaluation study of breast cancer was conducted, which among other questions examined the correlation of health insurance with type or quality of care delivered for breast cancer on a national basis. METHODS: The tumor registry system of the American College of Surgeons was used to obtain data on patients with breast cancer diagnosed in 1983 and 1990. Trends in diagnosis and treatment were correlated with the type of insurance or lack of insurance. RESULTS: Data were obtained from hospitals in 50 states on a total of 41,651 patients. The largest number of patients were covered by Medicare. Fewer than 5% were considered medically indigent. Medically indigent patients presented with higher stage disease and did not participate in a trend toward downstaging, which occurred between the two study years. The treatment of medically indigent patients appeared to be appropriate and comparable with better insured patients. Insurance type (health maintenance organization vs. private) did not affect stage, treatment, or outcome. Decisions to use controversial therapies, such as chemotherapy for stage I disease, did not appear to be financially driven. CONCLUSION: A nationwide pattern of care study for breast cancer indicates that medically indigent patients present with more advanced disease compared with better insured patients, but once the diagnosis is made, treatment and outcome have little to do with insurance type.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1983

Millions of medical care dollars for indigents.

The medically indigent, a group traditionally underserved with health care, can obtain some needed free services from Hill-Burton facilities. These facilities (hospitals, nursing homes, clinics, and agencies) received Hill-Burton funds for their building programs and have, as a result, an obligation to provide a certain amount of uncompensated medical care to a defined medically indigent population. Health systems agencies (HSAS) or other interested agencies and groups can play an integral role in highlighting the Hill-Burton Program and helping the medically indigent obtain free care, This paper describes the Hill-Burton Program and explains how one HSA identified the Hill-Burton facilities in its area, determined the extent of their obligations, obtained allocation plans, and publicized and promoted the available health care services. From the interest shown by the community it was apparent that the HSA had provided a much needed and appreciated service that could be duplicated across the country by HSAS or other community groups.

Financing, Government↗
PubMed1981

Patterns of Medicaid eligibility: a sample of 408 Medi-Cal eligibles in San Francisco, California.

Medicaid expenditures per recipient have increased substantially in the past decade, even after controlling for medical care price inflation. In response to this Medicaid expenditure growth, various policies to encourage Medicaid enrollment in cost-effective health maintenance organizations (HMOs) are being considered, including guaranteed Medicaid eligibility for Medicaid eligibles enrolled in HMOs. This paper addresses several important questions about Medicaid eligibility that are essential to an analysis of guaranteed eligibility--the length of eligibility, turnover rates, and reasons individuals lose their Medicaid eligibility. We selected a stratified random sample of 408 eligibility case files for individuals eligible for Medicaid in San Francisco County during December 1977. Six aid categories are represented in this study: (1) Cash Grant AFDC; (2) Medically Needy Families; (3) Medically Needy Aged; (4) Medically Needy Disabled; (5) Medically indigent Adults; and (6) Medically indigent Children. We found that the majority of individuals remain eligible for Medicaid for long, uninterrupted spells, ranging from a median of 15 months (Medically Indigent Adults) to 40 months (Medically Needy Aged). A much smaller subset of eligible persons had relatively short spells and higher turnover; some of that turnover was due to failure to comply with income reporting requirements. We used data on length of eligibility to estimate the cost impact of 6 months' guaranteed eligibility (for months during which individuals would otherwise not have been eligible for Medicaid benefits). We also estimated the potential benefits (savings of HMOs relative to average fee-for-service expenditures) and the benefits of guaranteed eligibility appear to be greater than the costs.

California↗
PubMedDate not supplied

Establishing an on-site pharmacy in a community health center to help indigent patients access medications and to improve care.

OBJECTIVES: To describe the establishment of an on-site pharmacy in a community health center (CHC) to improve access to medications for indigent patients, the implementation of pharmaceutical care programs and clinical pharmacy services to improve patient care and therapeutic outcomes, and the development of an ambulatory care site for training pharmacy students. SETTING: Partnership Health Center (PHC), a federally funded CHC in Missoula, Mont. PRACTICE DESCRIPTION: Establishment of an on-site pharmacy and strategies for accessing medications for indigent patients, including participation in the U.S. Public Health Service pricing program, pharmaceutical manufacturers' assistance programs, and drug sampling, are described. The clinical pharmacy, disease management, and pharmaceutical care programs developed at the site to improve medication use and therapeutic outcomes are discussed. Development of an ambulatory care clerkship site at the CHC for training University of Montana pharmacy students is reviewed. PRACTICE INNOVATION: Partnership between PHC and the University of Montana School of Pharmacy and Allied Health Sciences (SPAHS) to establish an on-site pharmacy to help medically indigent patients access medications and to improve care. INTERVENTIONS: Programs to help indigent patients access, adhere, and appropriately use needed medications while decreasing clinic expenditures for medications. MAIN OUTCOME MEASURES: Number of prescriptions dispensed per month, clinic expenditures on medications per month, and number of clinical services and pharmaceutical care programs developed. RESULTS: Between November 1, 1999, and April 30, 2000, the average number of prescriptions filled for PHC clients increased from 219/month to 838/month and the average expenditure per prescription decreased from $16.55/month to $0.51/month. A pharmacist-assisted refill program was implemented. Programs in diabetes, hypertension, dyslipidemia, asthma, anticoagulation, and peptic ulcer disease were developed. CONCLUSION: Establishing an on-site pharmacy in a CHC in collaboration with a school of pharmacy significantly improved indigent patients' access to medications while decreasing clinic expenditures. Pharmaceutical care programs improved therapeutic outcomes, and clinical pharmacy services complemented the clinical activities of other health care providers in managing chronic diseases and resolving drug-related problems. The CHC provided an excellent setting for training pharmacy students in ambulatory care.

Community Health Centers↗
PubMed2002

Managed care for uninsured adults: the rise and fall of a university-based program.

OBJECTIVE: To assess the impact of CU CARE, a managed care program for medically indigent adults developed by University Hospital (UH) in Denver and Kaiser Permanente, on outpatient and inpatient utilization. STUDY DESIGN: Pre-post study with concurrent comparison groups. PATIENTS AND METHODS: Administrative claims from 1994-1996 were analyzed for all enrollees in a state-funded medically indigent program (intervention group) compared with Medicaid patients and uninsured adults rated as "self-pay" who were ineligible for the medically indigent program. RESULTS: In 1994, before initiation of CU CARE, UH provided care to 10,118 medically indigent, 5330 Medicaid, and 7626 self-pay patients; similar numbers received care in 1995-1996, but only 12% of medically indigent patients received care in both time periods. The proportion of medically indigent patients with 1 or more primary care visits increased by 185% (from 10.9% in 1994 to 31.1% in 1995-1996). Medically indigent patients had relative declines of 36% in specialty clinic visits, 25% in emergency department visits, 40% in hospital visits, and 31% in visit costs between 1994 and 1995-1996. All these changes were significant compared with Medicaid and self-pay patients. The impact on acute care utilization was greater for medically indigent patients who used UH in both 1994 and 1995-1996. CONCLUSIONS: This managed care program increased utilization of primary care and reduced specialty and acute care utilization. However, the program was scaled back in 1997 and terminated in 2000 because of problems with care coordination across institutions, increasing costs (particularly pharmacy costs), and competitive pressures.

Adult↗
PubMed1993

Medical students' attitudes toward providing care for the underserved. Are we training socially responsible physicians?

OBJECTIVE: To investigate the association between attitudes toward caring for the medically indigent and years of medical training. DESIGN: Questionnaire comparing attitudes of first-year medical students (MS-Is) and fourth-year medical students (MS-IVs). SETTING: Southwest medical school. PARTICIPANTS: A total of 83 (67%) male and 41 (33%) female MS-I and 65 (73%) male and 24 (27%) female MS-IV volunteers. MAIN OUTCOME MEASURE: Self-report, attitudinal scale developed for this study that provided a measure of overall attitudes, perceived societal expectations, physician/student responsibility, personal efficacy, and provision of basic services and expensive procedures. RESULTS: Overall attitudes were significantly less favorable for MS-IVs (95% confidence interval [CI], 99.6 to 106.2) than MS-Is (95% CI, 109.5 to 114.3, P < .0001). Except for basic services (P = .46), MS-IVs had worse attitudes on all attitudes subscales. Male MS-IVs reported significantly less favorable attitudes than male MS-Is in the areas of general attitudes (P = .03) and physician/student responsibility (P = .01). Female medical students showed no significant differences across classes (P > .05). Except for physician/student responsibility, female medical students' attitudes were more favorable than those of males, regardless of class. CONCLUSIONS: The MS-IVs are less favorably inclined toward caring for the medically indigent than MS-Is, though these differences are apparent only for males. Further research is needed to explore why females appear to be more resistant to attitude changes, and what educational interventions are necessary to better train physicians to respond to national health care issues.

Attitude of Health Personnel↗
PubMed1993

Undocumented aliens and uncompensated care: whose responsibility?

Undocumented aliens concentrated in metropolitan areas and certain Sunbelt states can financially burden local health agencies and may interfere with access to health care for indigent populations that are legally resident. Data collected from Jackson Memorial Hospital, which provides the bulk of indigent medical services in Dade County, Florida, are used to investigate the problem of providing uncompensated care to undocumented aliens. Policy alternatives concerning immigration issues and reimbursement are discussed.

Florida↗
PubMed1987

Nonprofit hospitals in a competitive environment: behavior in the Arizona indigent care experiment.

The initial expectations of a group of urban nonprofit hospitals about the implementation of a prepaid, competitively bid program for the provision of indigent medical care were that their participation in the program would be limited to the provision of inpatient care on a subcontracted basis. In reality, as the program evolved, nonprofit hospitals played an increasingly active role which included the provision of care as a primary contractor on a full, risk-sharing basis. This evolution in nonprofit hospital behavior resulted from a change in the overall hospital environment in the community, as well as the somewhat negative experience of the hospitals as subcontractors and a more realistic assessment of the benefits and costs from participating in the program.

Arizona↗
PubMed1999

Refractive errors and visual acuity impairment among self-selected Hispanic, white, and black adults examined by the UCLA Mobile Eye Clinic.

BACKGROUND: Occurrence of refractive errors and uncorrected visual acuity impairment among self-selected, indigent, medically underserved Hispanic, white, and black adults examined by the staff of the UCLA Mobile Eye Clinic (MEC) are described in this study and compared to population-based studies. METHODS: The study sample consisted of all 2,970 Hispanic, 1,228 white, and 1,028 black participants, for a total of 5,226 self-selected adults, ages 25 to 74 years, who received vision screenings and eye examinations by the staff of the UCLA MEC from 1987 to 1997. Tests consisted of visual acuity, refractive error, intraocular pressure, retinoscopy, slit-lamp biomicroscopy, direct ophthalmoscopic examination, and indirect ophthalmoloscopy with pupillary dilation. Levels of visual acuity impairment were defined as mild (20/50-20/80), moderate (20/100), or severe (20/200 or worse) in either eye. RESULTS: Self-selected whites in this study had higher rates of astigmatism, anisometropia, and hyperopia, while myopia was higher among self-selected blacks. Myopia and hyperopia occurred more frequently among younger age groups for all ethnic groups. Whites had a higher occurrence of mild, moderate, and severe visual acuity impairment, as compared with Hispanics and blacks. CONCLUSIONS: Both refractive errors and impaired visual acuity of this self-selected sample are similar to those of adults from the National Health and Nutrition Examination Survey, Hispanic Health and Nutrition Examination Survey, and the Baltimore Eye Survey. The data presented in this study provide a crude estimate of the occurrence of refractive errors and impaired visual acuity among self-selected, medically underserved, indigent Hispanic, white, and black adults in the Los Angeles area.

Adolescent↗