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PubMed2006

Comorbid conditions in men with ED before and after ED diagnosis: a retrospective database study.

Although erectile dysfunction (ED) has been considered a complication of other medical conditions, clinicians and researchers suggest that ED may serve as a clinical marker of vascular health. This retrospective claims study examined the prevalence of predefined comorbid conditions in men with ED (N=301 994) in the 12 months before and the 6 months following ED diagnosis. Consistent with previous research, comorbid conditions were prevalent among men with ED. Comorbid conditions were most often diagnosed before an ED diagnosis, although new diagnoses in the 6 months following an ED diagnosis were common and occured more frequently than new diagnoses in a matched sample of men without ED during the same period. Differences by age, region and insurance coverage for ED medications were also examined. Findings support previous research that suggests ED may serve as a marker for previously undetected comorbid conditions.

Adolescent↗
PubMed1977

Demographic and clinical characteristics of black psychiatric patients in a private general hospital.

A study of 419 first admissions to a private general hospital psychiatric inpatient unit showed that only 8.8 per cent were blacks, while 23 per cent of the population in the community were blacks. When compared to white patients, blacks were much less likely to be rerred for hospitalization by private sources, were substantially younger, and had shorter hospitalizations. The most common diagnosis for blacks was paranoid schizophrenia. The authors conclude that despite the widespread availability of third-party insurance coverage, blacks use the private general hospital less ofter than whites and their patterns of use are substantially different.

Adolescent↗
PubMed1982

"Freedom of choice" laws: empirical evidence of their contribution to competition in mental health care delivery.

Freedom of Choice laws have been forwarded as laws which enhance consumer choice and efficient functioning of markets for mental health services. The name of these laws constitute a misnomer, because they serve to force consumers to buy a specific type of insurance coverage. Nevertheless, under a specific set of markets conditions, the implementation of Freedom of Choice laws may increase competition and improve efficiency in the market. Empirical estimates are reported of the effect on prices of this legislation.

Community Participation↗
PubMed1989

Commentary: the health policy agenda basic benefits package: implications for the uninsured.

With 37 million individuals lacking insurance, coverage for health services has become a national economic issue of growing importance. The Health Policy Agenda, a broad-based, consensus-oriented consortium, recently took a major step toward answering the question of what benefits all Americans should have. Chaired by former Utah Governor Scott M. Matheson, a Health Policy Agenda ad hoc committee developed a model basic benefits package to serve as a nonmandatory guide for both public and private health insurance plans.

Health Care Coalitions↗
PubMed1992

Fairness and feasibility in national health care systems.

The issue of National Health Care reform has been discussed from many different perspectives. One of the most fundamental justifications for such reform is based on the notion of horizontal equity. The motivation for equity in medical services use contrasts with the seeming lack of concern for equity in financing. Proposed policy remedies often involve transfers through taxation, though the effects of government taxation often reduce the efficiency of publicly financed health insurance. Further, the effects of heterogeneous preferences complicate the assessment of optimal medical service consumption levels. Ethical justification aside, this paper addresses the notion of fairness in the provision of medical care from an economic perspective. It suggests policies which might be most suitable in achieving such a goal. A paradoxical result of these considerations of fairness is that unequal insurance coverage is requisite to ensure more equal utilization of medical services by the population. The concept of fairness is then developed into a bottom up system of equity in the medical market.

Canada↗
PubMed2005

The effect of race/ethnicity and insurance in the administration of standard therapy for local breast cancer in Florida.

OBJECTIVES: Assess the effect of race/ethnicity and insurance coverage on the receipt of standard treatment for local breast cancer. METHODS: Local breast cancers diagnosed between July 1997 and December 2000 and reported to Florida's registry were linked to the Agency of Healthcare Administration inpatient and outpatient databases, resulting in 23,817 female local breast cancers with informative treatment. Standard treatment was defined as mastectomy or breast-conserving surgery followed by radiation therapy and it was modeled as a function of health insurance and race/ethnicity accounting for age at diagnosis, marital status and facility type. RESULTS: Approximately 88% of the local breast cancers received standard treatment. The likelihood of standard treatment decreased by 3% per year of increase in the age at diagnosis. Compared to white non-Hispanic, black non-Hispanic women were 19% less likely to receive standard treatment (OR=0.81, 95%CI=0.68, 0.97) and Hispanics were 23% less likely (OR=0.77, 95%CI=0.66, 0.89). Local breast cancers diagnosed in non-teaching facilities were 21% more likely to receive standard treatment compared to those diagnosed in teaching facilities (OR=1.21; 95%CI=1.05, 1.38)). Compared to single, married women were 51% more likely to get standard treatment (OR=1.51, 95%CI=1.31, 1.66), followed by separated or divorced women that were 37% more likely (OR=1.37, 95%CI =1.13, 1.66). Compared to the privately insured, Medicare beneficiaries were 36% more likely to receive standard treatment (OR=1.36, 95%CI=1.22, 1.51) whereas the uninsured were 24% less likely (OR=0.76, 95%CI=0.59, 0.96); Medicaid insured women were 29% less likely to receive standard treatment compared to the uninsured (OR=0.71, 95%CI=0.53, 0.96). CONCLUSION: Future efforts should target the elderly, Hispanic and black women, the uninsured, and those on Medicaid in order to reduce treatment disparities.

Adolescent↗
PubMed2006

Health insurance benefit packages prioritized by low-income clients in India: three criteria to estimate effectiveness of choice.

We applied a decision tool for rationing choices, with a predetermined budget of about 11 US dollars per household per year, to identify priorities of poor people regarding health insurance benefits in India in late 2005. A total of 302 individuals, organized in 24 groups, participated from a number of villages and neighborhoods of towns in Karnataka and Maharashtra. Many individuals were illiterate, innumerate and without insurance experience. Involving clients in insurance package design is based on an implied assumption that people can make judicious rationing decisions. Judiciousness was assessed by examining the association between the frequency of choosing a package and its perceived effectiveness. Perceived effectiveness was evaluated by comparing respondents' choices to the costs registered in 2049 illness episodes among a comparable cohort, using three criteria: 'reimbursement' (reimbursement regardless of the absolute level of expenditure), 'fairness' (higher reimbursement rate for higher expenses) and 'catastrophic coverage' (insurance for catastrophic exposure). The most frequently chosen packages scored highly on all three criteria; thus, rationing choices were confirmed as judicious. Fully 88.4% of the respondents selected at least three of the following benefits: outpatient, inpatient, drugs and tests, with a clear preference to cover high aggregate costs regardless of their probability. The results show that involving prospective clients in benefit package design can be done without compromising the judiciousness of rationing choices, even with people who have low education, low-income and no previous experience in similar exercises.

Choice Behavior↗
PubMedDate not supplied

Strategies for financing home healthcare.

Insurance coverage for home healthcare is often inadequate, especially in chronic or terminal illnesses. As a result, your patients or families may be faced with catastrophic medical expenses and find it necessary to explore creative approaches for financing home care.

Cost Control↗
PubMed1997

Retiree health benefits in the United States: a strategic critical management review.

This article provides a critical review of studies associated with retiree health benefits in the United States. An attempt is made to determine if logical conclusions or trends could be identified regarding this issue of health care policy debate. The forms of retiree health benefits are covered, as is a discussion of Medigap policies and insurance coverage for the elderly. Employer-sponsored retiree benefits and the effects of supplemental coverage on the use of services are also reviewed. Lastly, a discussion and conclusion regarding this research agenda is presented with a critical analysis of the health care policy management debate for the future.

Aged↗
PubMed1996

Health and a residential care population.

This article describes the health status of 234 severely mentally ill (SMI) persons residing in California's supervised residential care facilities in 1973. Relocated in 1983, 63.2% reported their health as good to excellent. Over the follow-up period 80.8% maintained their SSI benefits, insuring them of health insurance coverage. Surprisingly the follow-up sample, believed to be at high risk of increased physical morbidity, compared quite favorably to low income subsamples of the National Health Interview Survey (NHIS). The SMI reported better health, access to and utilization of health services. Differences were particularly striking in the poor health category with NHIS respondents reporting poor health 3.5 times more frequently than SMI sample numbers. These results offer some support for the contribution of health insurance benefits and supervised residential settings to positive health outcomes of this vulnerable population.

Adult↗
PubMed1994

Sex differences in the management and long-term outcome of acute myocardial infarction. A statewide study. MIDAS Study Group. Myocardial Infarction Data Acquisition System.

BACKGROUND: We wished to evaluate whether differences in the rate of invasive cardiac procedures between men and women with acute myocardial infarction are associated with different short- and long-term mortality. METHODS AND RESULTS: The database (Myocardial Infarction Data Acquisition System, MIDAS) included all discharges for the years 1986 and 1987 with the diagnosis of acute myocardial infarction in New Jersey, based on the New Jersey hospital discharge data system (MIDS/UB-82). Accuracy of the data was evaluated by auditing 726 randomly selected charts. The variables examined included age, sex, race, comorbidity (anemia, chronic liver disease, cancer, chronic obstructive pulmonary disease, diabetes, hypertension, prior myocardial infarction), complications (left ventricular dysfunction, arrhythmias, conduction defects), insurance status, performance of cardiac catheterization, percutaneous transluminal coronary angioplasty, or coronary artery bypass graft surgery, and survival up to 3 years. Women were older, had longer hospital stay, and were more likely than men to have anemia, diabetes, hypertension, left ventricular dysfunction, and Medicare or Medicaid insurance coverage. They were less likely than men to be admitted to a hospital equipped to perform invasive procedures or to have chronic obstructive pulmonary disease, chronic liver disease, prior myocardial infarction, or arrhythmias. After adjustment for these differences, women were less likely than men to have cardiac catheterization. Cardiac catheterization was associated with lower mortality. Women up to age 70 had higher 3-year death rates than men after adjustment for age, race, comorbidity, complications, and insurance type. This difference between men and women was somewhat diminished after the performance of cardiac catheterization and revascularization was taken into account. Unadjusted mortality was high in this study group. CONCLUSIONS: Women with acute myocardial infarction are less likely to have invasive cardiac procedures and have higher 3-year adjusted death rate up to age 70 than men.

Aged↗
PubMed2005

Importance of generational status in examining access to and utilization of health care services by Mexican American children.

OBJECTIVES: To describe the sociodemographic differences among Mexican American children (first, second, and third generation), non-Hispanic black children, and non-Hispanic white children; to compare the health status and health care needs of Mexican American children (first, second, and third generation) with those of non-Hispanic black children and non-Hispanic white children; and to determine whether first-generation Mexican American children have poorer health care access and utilization than do non-Hispanic white children, after controlling for health insurance status and socioeconomic status. METHODS: The Third National Health and Nutrition Examination Survey was used to create a sample of 4372 Mexican American children (divided into 3 generational groups), 4138 non-Hispanic black children, and 4594 non-Hispanic white children, 2 months to 16 years of age. We compared parent/caregiver reports of health status and needs (perceived health of the child and reported illnesses), health care access (usual source of health care and specific provider), and health care utilization (contact with a physician within the past year, use of prescription medications, physician visit because of earache/infection, and hearing and vision screenings) for different subgroups within the sample. RESULTS: More than two thirds of first-generation Mexican American children were poor and uninsured and had parents with low educational attainment. More than one fourth of first-generation children were perceived as having poor or fair health, despite experiencing similar or better rates of illnesses, compared with other children. Almost one half of first-generation Mexican American children had not seen a doctor in the past year, compared with one fourth or less for other groups. Health care needs among first-generation Mexican American children were lower, on the basis of reported illnesses, but perceived health status was worse than for all other groups. After controlling for health insurance coverage and socioeconomic status, first-generation Mexican American children and non-Hispanic black children were less likely than non-Hispanic white children to have a usual source of care, to have a specific provider, or to have seen or talked with a physician in the past year. CONCLUSIONS: Of the 3 groups of children, Mexican American children had the least health care access and utilization, even after controlling for socioeconomic status and health insurance status. Our findings showed that Mexican American children had much lower levels of access and utilization than previously reported for Hispanic children on the whole. As a subgroup, first-generation Mexican American children fared substantially worse than second- or third-generation children. The discrepancy between poor perceived health status and lower rates of reported illnesses in the first-generation group leads to questions regarding generalized application of the "epidemiologic paradox." Given the overall growth of the Hispanic population in the United States and the relative growth of individual immigrant subgroups, the identification of subgroups in need is essential for the development of effective research and policy. Furthermore, taking generational status into account is likely to be revealing with respect to disparities in access to and utilization of pediatric services.

Adolescent↗
PubMedDate not supplied

Seniors with chronic health conditions and prescription drugs: benefits, wealth, and health.

OBJECTIVES: The objectives of this study were to examine the relationship between prescription benefit status and access to medications among Medicare beneficiaries with hypertension, congestive heart failure, coronary artery disease, and diabetes and to determine how income, wealth, and health status influence this relationship. METHODS: We analyzed survey and administrative data for 4492 Medicare + Choice enrollees aged 67 and above enrolled in a predominantly group-model health maintenance organization in 2000. Outcome measures included difficulty affording medications, methods of coping with medication costs including obtaining medicines from another country, using free samples, and stretching out medications to make them last longer. Independent variables included prescription benefit status, income, wealth measures, health status, and out-of-pocket prescription drug spending. RESULTS: Lacking a prescription benefit was independently associated with difficulty affording medications (25% of those without a benefit vs. 17% with a benefit) and coping methods such as stretching out medications. Lower income, lower assets, and worse health status also independently predicted greater difficulty as measured by these outcomes; there was no effect modification between these factors and benefit status. Relative to national figures, out-of-pocket spending in this setting was quite low, with only 0.2 and 13% of those with and without a benefit, respectively, spending over 100 dollars per month. Higher out-of-pocket spending predicted greater difficulty affording medications but not stretching out medications. CONCLUSIONS: Efforts to improve medication accessibility for older Americans with chronic conditions need to address not only insurance coverage but also barriers related to socioeconomic status and health status.

Aged↗
PubMed2005

Primary care experiences of people with psychiatric disabilities: barriers to care and potential solutions.

This study examined the barriers that 16 focus group participants with psychiatric disabilities confront in obtaining primary care services and their recommendations on improving quality of care. They cited a) difficulty identifying a primary care physician with good empathic and communication skills, b) physicians' misunderstanding of the nature of psychiatric disability, c) inadequate information about the side effects of psychotropic medications, and d) costs due to inadequate insurance coverage. In addition to suggestions for improving patient-physician communication and expanding physician knowledge, participants emphasized strategies to become empowered in their relationships with physicians and to obtain personal support.

Adult↗
PubMed2002

Health equity in transition from planned to market economy in China.

This paper examines the impact of economic transition and health sector reform on health equities in the urban and rural populations of China in the 1990s. Since 1980, China has experienced a rapid economic development and fundamental transformation of its society. Three secondary data sources were used as the basis for the analysis and discussion: mortality data from the National Death Notification System; infant mortality from the National Maternal and Child Health Surveillance System; and morbidity, health care utilization and financing data from the National Health Household Interview Surveys. The analysis revealed a very complex picture with: general mortality rates decreasing in both urban and rural populations, but the differences between urban and rural increasing; declining infant mortality rates with narrowing of the urban-rural gap; health care needs declining in both urban and rural populations, but more rapidly in the urban areas; health service payments increasing in both urban and rural areas, while, at the same time, health insurance coverage decreased. The analysis suggests that despite overall improvements in the population's health status, the economic and health system policy reforms are leading to increased inequities in health care. The lowest income quintiles in both urban and rural areas are receiving less health care compared with their needs in 1998 than in 1993, and the urban-rural divide, in particular with regard to receiving inpatient health care, is widening appreciably. The reform of the health insurance system, combined with the market setting of prices for care, have had profound implications for all population groups, in particular the lower income segments and the rural populations. During the period 1993-98 the proportion of the urban population that had to cover the increasing cost of medical care themselves doubled.

China↗
PubMed1984

Access to health care among aged Medicare beneficiaries.

The goal of the National Medical Care Utilization and Expenditure Survey (NMCUES) is to improve the understanding of the ways in which Americans use and pay for health care. This report is one in a series of descriptive reports based on NMCUES data. Data concerning several aspects of participants' access to health care services were collected in NMCUES. These included identification of a regular source of care, several characteristics of physical access to the regular source (transportation mode, travel time, waiting room time), insurance coverage, and the existence of medically unattended conditions. The purpose of this report is to provide descriptive information about selected aspects of access to health care among noninstitutionalized elderly people who reported being covered by Medicare. The results presented are based on data collected about noninstitutionalized people in the NMCUES national household sample who: (1) were 65 years of age and over at any time during the survey year, and (2) reported being covered by Medicare Hospital Insurance, Supplementary Medical Insurance, or both during the survey year (1980). The regular source of care for three out of four (74 percent) of the elderly Medicare beneficiaries was a physician's office (including group practice or doctor's clinic), while for 9 percent the regular source was a hospital outpatient clinic, emergency room, health center, or other provider type (referred to hereafter as "clinic"). Of the elderly Medicare beneficiaries, 10 percent reported no regular source of care, and the regular source was unknown for 7 percent. Of those with no regular source of care, 80 percent identified their seldom getting sick as an important reason for having no regular source, 24 percent identified their desire to go to different places for different health care needs, 14 percent said their usual source was no longer available, and 5 percent identified their recently moving into the area as an important reason. Nearly six out of ten (59 percent) of the elderly Medicare beneficiaries who reported that their regular source was a physician's office drove themselves there, and about four out of ten (43 percent) of those who reported that their regular source was a clinic drove themselves to the clinic. On the average, people traveled nearly 10 minutes more to a clinic than to a physician's office (29 versus 20 minutes). There was little variability in reported length of travel time among the various demographic categories--e.g., men tended to travel for the same length of time as did women, black people for the same travel time as white people.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed2005

Dental visits and access to dental care among Maryland schoolchildren.

BACKGROUND: Regular dental visits afford an opportunity for dentists to provide preventive services and to diagnose and treat disease. Not all children, however, have equal access to these services. METHODS: The authors conducted this study to describe access to and utilization of oral health care services for Maryland schoolchildren in kindergarten and third grade. They obtained data from a questionnaire filled out by parents or guardians participating in the Survey of the Oral Health Status of Maryland School Children, 2000-2001 (N = 2,642). Outcome variables included having a dental visit in the last year, prophylaxis in the last year, usual source of medical care and usual source of dental care. Descriptor variables included region, grade, race/ethnicity, eligibility for free or reduced-fee meals, parents' or guardians' education and dental insurance status. RESULTS: Overall, general dental visit and dental prophylaxis visit rates were similar (74.1 and 71.3 percent, respectively). Schoolchildren, however, were more likely to have had a usual source of medical care than of dental care (96.0 and 82.9 percent, respectively). Third graders, those ineligible for free or reduced-fee meals and those with some dental insurance coverage were more likely to have received a prophylaxis in the last year and were more likely to have a usual source of dental care. Non-Hispanic white and non-Hispanic black schoolchildren also were more likely to have had a usual source of dental care than were Hispanics. CONCLUSIONS: Schoolchildren most likely to have received regular preventive dental care were those who had parents or guardians with financial resources. Medicaid and State Children's Health Insurance Program (SCHIP) provide safety nets, but these programs could be improved. PRACTICE IMPLICATIONS: Dentistry's challenge is to determine which characteristics are unique to those who visit the dentist regularly and use this information to help meet the needs of the underserved.

Black or African American↗
PubMed1994

After rehabilitation: meeting the long-term needs of persons with traumatic brain injury.

Many survivors of traumatic brain injury have significant needs for long-term support. The rehabilitation professions, including occupational therapy, have begun to recognize these needs more fully during the last decade. The literature describes various models of supported living that provide housing, support services, and vocational assistance; however, these programs are not widely available due to limitations in public funding and inadequate insurance coverage for long-term care. Occupational therapists can contribute a broad expertise to the provision of supported living services, and the profession is encouraged to provide leadership and advocacy with respect to the long-term care needs of survivors of traumatic brain injury.

Adult↗