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PubMed1991

Access to high-tech health care. Ethics.

Access to health care has always been limited by personal and social economics. Poverty remains one element that correlates with poor prognosis in all varieties of cancer. Prior to becoming standard therapy, elements of high-tech health care are often widely available as research protocols, participation in which is generally available without considerations of insurance coverage or personal wealth. Any person may still volunteer participation in research protocols and thereby partake in high-tech advances even before these become standard therapy. However, recent developments in the conduct of research now may limit participation. Medicare and third party insurance payers proscribe payment for research project care and always have. Recently, more than ever before, reimbursements to physicians and health care institutions have been more closely scrutinized to reject all payment in research settings. In situations in which cost and availability of the new technology, whether machine or drug, limit participation, research entrepreneurs have made research participation available to only those who can pay for it. These and similar developments threaten to limit access to high-tech health care and to actually impede cancer research.

Beneficence↗
PubMed2004

Quality safeguards and regulation of online pharmacies.

Using econometric evidence, this article confirms that distribution of medicines online is split into two market segments of very diverse quality, and identifies the factors that drive quality and quality assurance in this activity. Unlike fraudulent, 'rogue,' websites, which offer scant guarantees and usually sell just a few medicines without prescription, online pharmacies offering insurance coverage and linked to conventional pharmacies typically sell a whole range of drugs, require third-party medical prescriptions and provide abundant information to patients. It is shown that, where online pharmacies are allowed to act legally, market forces enhance quality, as private insurers require professional standards, and specialized third parties make a business of certifying them. Furthermore, older online pharmacies and those running conventional operations offer higher quality, probably because of reputational investments. Overall, this evidence supports licensing online pharmacies, especially considering that prohibiting them is ineffective against fraudulent sites.

Commerce↗
PubMed2000

Utilization of specialty mental health care among persons with severe mental illness: the roles of demographics, need, insurance, and risk.

OBJECTIVE: To examine the sociodemographic, need, risk, and insurance characteristics of persons with severe mental illness and the importance of these characteristics for predicting specialty mental health utilization among this group. DATA SOURCE: The Healthcare for Communities survey, a national study that tracks alcohol, drug, and mental health services utilization. Data come from a telephone survey of adults from 60 communities across the United States, and from a supplemental geographically dispersed sample. STUDY DESIGN: Respondents were categorized as having a severe mental disorder, other mental disorder, or no measured mental disorder. Differences among groups in sociodemographics (gender, marital status, race, education, and income), insurance coverage, need for mental health care (symptoms and perceived need), and risk indicators (suicide ideation, criminal involvement, and aggressive behavior) are examined. Measures of service use for mental health care include emergency room, inpatient, and specialty outpatient care. The importance of sociodemographics, need, insurance status, and risk indicators for specialty mental health care utilization are examined through logistic regression. PRINCIPAL FINDINGS: The severely mentally ill in this study are disproportionately African American, unmarried, male, less educated, and have lower family incomes than those with other disorders and those with no measured mental disorders. In a 12-month period almost three-fifths of persons with severe mental illness did not receive specialty mental health care. One in five persons with severe mental illness are uninsured, and Medicare or Medicaid insures 37 percent. Persons covered by these public programs are over six times more likely to have access to specialty care than the uninsured are. Involvement in the criminal justice system also increases the probability that a person will receive care by a factor of about four, independent of level of need. The average number of outpatient visits for specialty care varies little across type of disorder, and the median number of visits (ten) is equivalent for those with a severe mental illness and those with other disorders. CONCLUSIONS: Persons with severe mental illness have a high level of economic and social disadvantage. Barriers to care, including lack of insurance, are substantial and many do not receive specialty care. Public insurance programs are the major points of leverage for improving access, and policy interventions should be targeted to these programs. Problems of adequate care for the severely mentally ill may be exacerbated by the managed care trend to reductions in intensity of treatment.

Acute Disease↗
PubMed1993

Insurance status among people with AIDS: relationships with sociodemographic characteristics and service use.

This paper presents data on health insurance coverage among people with AIDS. The data came from interviews with 937 people with AIDS recruited from outpatient HIV clinics and community-based AIDS service organizations in nine communities across the United States. At the time of the interview, 30% had private insurance, 29% had no insurance, and 41% were covered by some form of public health insurance. Respondents who were nonwhite, injected-drug users, unemployed, and had incomes of less than $500 per month were more likely than their respective counterparts to have no insurance or to have publicly funded insurance. There were marked regional variations in insurance status, with the South having the highest proportion of of uninsured and the lowest proportion receiving Medicaid. Ninety-five percent of the uninsured and the publicly insured, compared to 47% of those with private insurance, used clinics as their source of medical care. People without insurance were less likely than those with private insurance to have been admitted overnight to a hospital, and their lengths of stay were shorter.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Insurance and acupuncture.

Insurance coverage for acupuncture is limited. The few companies that will cover acupuncture do so only when treatments are considered medically necessary.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Spells without health insurance: distributions of durations and their link to point-in-time estimates of the uninsured.

To be able to design effective policies that will provide financial access to medical care to the uninsured, we need to know how many people experience long versus short spells without health insurance. Previous studies of the characteristics of the uninsured have relied almost exclusively on data from a point in time. Using the Survey of Income and Program Participation (SIPP), this paper provides a link between the distributions of four characteristics of the uninsured at a point in time and the expected uninsured spell lengths of people in specific subgroups of each characteristic. Our findings indicate that half of all uninsured spells end within 4 months while only 15% last longer than 24 months. Also, people who are employed (either full-time or part-time) in the first month of an uninsured spell are highly likely to have short uninsured spells, while people who are unemployed or out of the labor force are more likely to have long uninsured spells. This implies that efforts to increase health insurance coverage via employer mandates should proceed cautiously until we know how many people with long uninsured spells are employed.

Adult↗
PubMed2005

Health, healthcare utilization, and satisfaction with service: barriers and facilitators for older Korean Americans.

The present study assessed predictive models of subjective perception of health, healthcare utilization (hospital visits), and satisfaction with healthcare service using a sample of 230 older Korean Americans. Predisposing characteristics (age, sex, and education), health needs (chronic conditions, functional disability, and number of sick days), and a variety of enabling factors (health insurance, English speaking ability, transportation, living arrangement, trust in Western medicine, and reported experience of disrespect in medical settings) were considered. After controlling for predisposing and need factors, health insurance coverage was found to be a significant enabling factor for hospital visits. Subjective perception of health was found to be significant not only for healthcare utilization, but also for satisfaction with service. A greater likelihood of satisfaction was also observed in individuals with health insurance, better English-speaking ability, and greater trust in Western medical care. The reported experience of disrespect or discrimination in medical settings significantly reduced the odds of satisfaction with service.

Aged↗
PubMed1989

Demand analysis of mental health service use among ethnic subpopulations.

This paper estimates demand for mental health services by blacks, Hispanics, and whites, as well as males and females, using a three-part regression model. It examines the probability of mental health use and the level of outpatient and inpatient use. The data base is the high option Blue Cross/Blue Shield Federal Employee Health Benefits Plan for the 1979 to 1981 period. All user subpopulations sharing this plan have the same coverage, so differences in demand and utilization are related to ethnic and racial background, age, salary, outpatient visit copayment and market area characteristics, including the supply of psychiatrists. Results show vast differences in demand for care by ethnic, racial, and gender groups with identical insurance coverage. Alternative explanations for the differences are suggested.

Black or African American↗
PubMed1986

Variations in respiratory disease morbidity among pulp and paper mill town residents.

This study investigated whether occupational exposure in pulp and paper mills or geographic proximity to mills was associated with an increase in risk for respiratory disease hospitalizations. Three years (1980 to 1982) of 100% age- and sex-adjusted hospital admission rates for selected respiratory diagnoses were calculated for 66 Maine towns located between 0 and 15 miles for seven Kraft mills and four groundwood pulp and paper mills. Additional data collected for each town included the number of production workers at each mill, mill proximity, insurance coverage, hospital distance, bed size, full-time equivalent physicians, unemployment and income rates. Regression results provide evidence that occupational exposure may be a significant factor in hospitalizations for respiratory infections, bronchitis and asthma, and respiratory signs and symptoms, although potential confounders (smoking, commercial health insurance) need to be examined.

Aged↗
PubMed1995

Employment-based health insurance: implications of the sampling unit for policy analysis.

One of the least understood aspects of using employer data for the health reform debate concerns important differences between enterprise- and establishment-level surveys of employers. We demonstrate that the choice of sampling unit affects the size distribution of employees between large and small firms, as well as the estimated proportion of firms offering health insurance. Because health insurance decisions in multi-establishment enterprises generally are made for the entire enterprise rather than individual establishments, we conclude that enterprise surveys are most appropriate for collecting information on the factors affecting the decision to provide health insurance coverage. Nevertheless, an establishment-level survey may be preferred for evaluating decisions made at the state, regional, or industry level. But establishment-level surveys will underestimate the impact of an employer mandate on the unit that ultimately makes the decision to offer health insurance--the enterprise. Given the enormous human and financial stakes involved in health care reform, we urge policymakers and analysts to reflect on the strengths and limitations of alternative sampling units, and to consider the implications for interpreting survey data and formulating policy decisions.

Fee-for-Service Plans↗
PubMedDate not supplied

How adequate are state data to support health reform or monitor health system change?

This article reports on results of a 1994 telephone survey sponsored by the Robert Wood Johnson Foundation to obtain better information on state policymakers' views of the quality of state-based health data and selected information on the actual data available. The findings suggest that state policymakers cannot identify easily who and how many are without health insurance coverage, nor do they know exactly how much money is spent in the state on health care and who spends it. They also cannot ascertain quality or consumers' satisfaction with health plans. Funding, lack of comparability across data sets, and the reluctance of providers and insurers to submit required data are perceived as barriers to improving data. Adopting realistic strategies to overcome these barriers may be crucial if states are to assume greater leadership in health policy and in monitoring health system performance.

Cost Control↗
PubMed2000

Does medical insurance contribute to socioeconomic differentials in health?

Both access to insurance and health itself vary widely by socioeconomic status (SES). Are socioeconomic variations in health linked to insurance coverage or to factors that lie outside the medical care arena? Data from the Aging, Status, and the Sense of Control Survey were the basis of a representative U.S. national telephone survey conducted in 1995, and again in 1998. The results showed that persons with private insurance do not differ significantly from the uninsured in their self-reported health, physical functioning, or number of chronic conditions, whereas persons with public insurance report significantly worse health and more chronic conditions than the uninsured. These longitudinal results hold with adjustment for baseline health, SES, change in social status, and the hazard of attrition. Medical insurance does not mediate any associations between SES and health. Medical insurance of all kinds, however, does reduce difficulties in paying medical bills, and Medicaid is associated with more doctor visits and prescription drugs.

Adult↗
PubMedDate not supplied

Outcomes and effectiveness research in the private sector.

Private-sector health care organizations increasingly tout the use of outcomes and effectiveness research in activities ranging from pharmaceutical research to insurance coverage determinations. The rapid development of this research raises important questions about the role of the Agency for Health Care Policy and Research (AHCPR) as the producer, funder, and champion of outcomes and effectiveness research. To address this issue, we reviewed the activities of pharmaceutical companies, insurers, managed care organizations, health information technology companies, and other private-sector actors in outcomes and effectiveness research. We found that it is being used in a focused way to promote business goals and other organizational objectives, particularly in the pharmaceutical, insurance, and managed care industries. We also found significant gaps in its application to important public health issues and virtually no overlap with prior federal activities in this area.

Health Services Research↗
PubMed1993

Universal access to health care: a practical perspective.

Policy disconnected from economic reality is bad policy. Neither government financed health insurance nor an employer mandated health insurance approach are in the national interest. Higher national priorities compel a reallocation of resources from consumption to investment. This need not, however, cause an abandonment of efforts to deal with the problems of the uninsured and other health reforms. Successful health care reform is achievable provided it is responsive to higher priorities for economic growth. A strong economy and the production of wealth are indispensable to economic justice. Toward this end, a program of universal access is proposed whereby families and individuals are required to pay for their own health insurance up to a fixed percentage of disposable personal income before public payments kick in. Government's chief role is to establish a standard package of cost-effective benefits to be offered by all insurance carriers, the cost of which is approximately 40 percent less than conventional insurance coverage because of the elimination of reimbursement for clinically non-efficacious and cost-ineffective services. Public financing is relegated to a residual role in which subsidies are targeted on the needy. Much of the momentum for cost control is transferred to consumers and private insurers, both of whom acquire a vested interest in obtaining value for money. Uniform rules for underwriting, eligibility, and enrollment practices guard against socially harmful practices such as experience rating and exclusion of preexisting conditions. The household responsibility and equity plan described herein could free up as much as $90 billion or more for public investment in economic growth and national debt reduction while assuring access to health care regardless of ability to pay. Economic revitalization will be assisted by changes in household savings. With health care no longer a free good and government social programs concentrated on the truly needy, individual propensity to save will increase, thereby enlarging the pool of capital for financing investments in economic growth. Putting more responsibility for health care financing on households with an ability to pay also serves to reinforce and expand the work ethic. Privatizing responsibility by severing health insurance from the workplace connection improves the geographic and occupational mobility of labor, diminishes employer tendencies to discriminate against hiring the disabled and older employees, and eliminates a major source of labor unrest.(ABSTRACT TRUNCATED AT 400 WORDS)

Community Participation↗
PubMed2001

Health care reform in Japan.

Concentration of outpatients in major hospitals has been one of the major problems, and division of labor between clinics and hospitals is being strongly proposed as a policy. However, it is rather a structural problem and it runs counter to basic principle of free access to medicine by the public under our universal high insurance coverage policy. Another problem is excess number of hospital beds and long hospitalization. In order to save the extraordinarily expanding national medical expenditures, correction of these situations to the global standard is mandatory. It is the time to look over again the critical situation of our insurance system. Hospitals are suffering from frequently changing frivolous micro-policy. Comprehensive approach through macro-policy based on opinions by actually engaged persons, should be the linchpin of reforms for Japan's health care reform.

Health Care Reform↗
PubMed2002

Inner-city African American women who failed to receive cancer screening following a culturally-appropriate intervention: the role of health insurance.

Culturally-appropriate health promotion programs are thought to be more effective among minority groups than those designed for the population at large. We investigated factors associated with failure to obtain cervical and breast cancer screening among inner-city African American women who received a culturally-appropriate educational intervention. Women who completed the intervention, but did not obtain a Pap smear, a clinical breast examination, and/or a mammogram at follow-up were compared with those who did obtain these tests. Women with private health insurance were more likely to be screened following the intervention than those covered by Medicaid or Medicare or those who were not insured (P < 0.001). Post-intervention screening was not associated with age, education, income, employment, or marital status. The effectiveness of a culturally-appropriate intervention is likely to be reduced if women's ability to respond is limited by inadequate insurance coverage.

Adolescent↗
PubMed1993

Outpatient parenteral therapy. Management of serious infections. Part I: Medical, socioeconomic, and legal issues. Selecting the patient.

Careful patient selection is vital to the success of outpatient parenteral antibiotic therapy. As more experience has been gained, criteria for acceptance have expanded. Up to 50% of patients now originate from physicians' offices and other nonhospital settings. Currently, medical stability, insurance coverage, and availability of experienced personnel are the major selection criteria.

AIDS-Related Opportunistic Infections↗
PubMed2004

Racial and ethnic variations in knowledge and attitudes about genetic testing.

This study was designed to shed light on whether differences in utilization of genetic testing by African-Americans, Latinos, and non-Hispanic Whites are due primarily to different preferences, or whether they instead reflect other values and beliefs or differential access. It explores the values, attitudes, and beliefs of African-Americans, Latinos, and non-Hispanic Whites with respect to genetic testing by means of a telephone survey of representative samples of these three groups. The study finds clear evidence that Latinos and African-Americans are, if anything, more likely to express preferences for both prenatal and adult genetic testing than White respondents. At the same time, they hold other beliefs and attitudes that may conflict with, and override, these preferences in specific situations. African-Americans and Latinos are also less knowledgeable about genetic testing than non-Hispanic Whites, and they are less likely to have the financial resources or insurance coverage that would facilitate access to testing.

Black or African American↗