Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “coverage”

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 1,675 records · Page 93Linked to original sources
PubMedDate not supplied

The commercial health insurance industry in an era of eroding employer coverage.

This paper analyzes the commercial health insurance industry in an era of weakening employer commitment to providing coverage and strengthening interest by public programs to offer coverage through private plans. It documents the willingness of the industry to accept erosion of employment-based enrollment rather than to sacrifice earnings, the movement of Medicaid beneficiaries into managed care, and the distribution of market shares in the employment-based, Medicaid, and Medicare markets. The profitability of the commercial health insurance industry, exceptionally strong over the past five years, will henceforth be linked to the budgetary cycles and political fluctuations of state and federal governments.

Adolescent↗
PubMed2006

Status report on Medicare Part D enrollment in 2006: analysis of plan-specific market share and coverage.

The centerpiece of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 was the Part D drug benefit, provided through new stand-alone prescription drug plans (PDPs) and Medicare Advantage prescription drug (MA-PD) plans. We examine 2006 Part D enrollment data to analyze organization- and plan-level market share and enrollment by plan type, benefit design, and gap coverage. Ten organizations captured 72 percent of Part D enrollment, primarily in low-premium plans and those with name recognition. More than twelve million Part D enrollees without low-income subsidies enrolled in plans with limited or no gap coverage in 2006, but the number with actual spending in the gap remains to be seen.

Aged↗
PubMedDate not supplied

The Institute of Medicine committee's clarion call for universal coverage.

The Institute of Medicine (IOM) Committee on the Consequences of Being Uninsured is to be commended for its work, which recently culminated in the release of six volumes on the subject. The concluding volume presents a vision for universal coverage and describes four options for achieving it. The options include an incremental approach, employer and individual mandates, and a single-payer plan. We identify complications involving benefits and geographic variation in costs surrounding attempts to achieve universal coverage. The complications suggest that the committee's cost estimates may be too low and that there may be sizable political barriers to the proposals.

Geography↗
PubMedDate not supplied

Effects of generic-only drug coverage in a Medicare HMO.

Rising pharmacy costs and demand for prescription drug coverage for broader populations of seniors have resulted in the implementation of generic-only pharmacy benefits in Medicare health maintenance organizations (HMOs). The impact on cost and quality of care is unknown. We examined data for members of a California Medicare HMO whose coverage changed to a generic-only benefit and found that the change was associated with reduced health plan pharmacy cost, increased out-of-pocket pharmacy costs for members, increased overall hospital admissions, changed drug-use patterns, and a negative impact on quality metrics for certain conditions. These findings have important implications for future research and health policy decisions.

Aged↗
PubMed1999

A randomized study of tracking with outreach and provider prompting to improve immunization coverage and primary care.

OBJECTIVE: To compare and measure the effects and cost-effectiveness of two interventions designed to raise immunization rates. SETTINGS: Nine primary care sites serving impoverished and middle-class children. SUBJECTS: Complete birth cohorts (ages 0 to 12 months; n = 3015) from these sites. INTERVENTIONS: Two 18-month duration interventions: 1) tracking with outreach [tracking/outreach] to bring underimmunized children to their primary care provider office, and 2) a primary care provider office policy change to identify and reduce missed immunization opportunities (prompting). DESIGN: Randomized, controlled trial, randomizing within sites using a two-by-two factorial design. Subjects were allocated to one of four study groups: control, prompting only, tracking/outreach only, and combined prompting with tracking/outreach. Outcomes were obtained by blinded chart abstraction. MEASURES: Immunization status for age; number of days of delay in immunization; primary care utilization; and rates of screening for occult disease. RESULTS: Out of 3015 subjects, 274 subjects (9%) transferred out of the participating sites or had incomplete charts and were excluded. The 2741 (91%) remaining subjects were assessed. At baseline, study groups did not differ in age, gender, insurance type, or immunization status. Of the remaining subjects, 63% received Medicaid. Final series-complete immunization coverage levels were: control, 74%; prompting-only, 76%; tracking/outreach-only 95%; and combined tracking/outreach with prompting, 95%. Analysis of variance showed that: 1) tracking/outreach increased immunization rates 20 percentage points; 2) tracking/outreach decreased mean immunization delay 63 days; 3) tracking/outreach increased mean health supervision visits 0.44 visits per child; 4) tracking/outreach increased mean anemia screening 0.17 screenings per child and mean lead screenings 0.12 screenings per child; 5) impact of tracking/outreach was greatest for uninsured and impoverished patients; and 6) the prompting intervention had no impact on the studied outcomes, and its failure was caused by inconsistent use of prompts and failure to vaccinate ill children when prompted. Using tracking/outreach, the cost per additional child fully immunized was $474. Each $1000 spent on the tracking/outreach intervention resulted in: 2.1 additional fully vaccinated children and 668 fewer child-days of delayed immunization; 4.6 additional health supervision visits and 5.9 additional other visits to the primary care provider; and 1.8 additional anemia screenings and 1.3 additional lead screenings. CONCLUSIONS: Outreach directed toward children not up-to-date on immunizations improves not only immunization status, but also health supervision visit attendance and screening rates. The cost per additional child immunized was high, but should be interpreted in view of the spillover benefits that accompanied improved immunization. Effective means to improve coverage by reducing missed immunization opportunities still need to be identified.

Analysis of Variance↗
PubMed2000

Hepatitis B immunization coverage among Vietnamese-American children 3 to 18 years old.

OBJECTIVE: Persons with chronic hepatitis B virus (HBV) infection are at increased risk of chronic hepatitis, cirrhosis, and liver cancer. Although HBV infection is relatively uncommon in the United States, the disease is endemic in persons born in Southeast Asia, including Vietnamese-Americans. Current US infant immunization recommendations and state-mandated school-entry programs have left many nontargeted age-cohorts unvaccinated and at risk of infection. To assess the need for catch-up hepatitis B immunizations, this study reports the hepatitis B immunization rates of Vietnamese-American children 3 to 18 years old living in the metropolitan areas of Houston and Dallas, Texas, and the Washington, DC, area. DESIGN: We conducted 1508 telephone interviews with random samples of Vietnamese households in each of the 3 study sites. We asked for hepatitis B immunization dates for a randomly selected child in each household. Attempts were made to verify immunization dates through direct contact with each child's providers. Low and high estimates of coverage were calculated using reports from providers when reached (n = 720) and for the entire sample (n = 1508). RESULTS: Rates of having 3 hepatitis B vaccinations ranged from 13.6% (entire sample) to 24.1% (provider reports, Dallas), 10. 3% to 26.4% (Houston), and 18.1% to 37.8% (Washington, DC). Children living in the Texas sites, older children, children whose families had lived in the United States for a longer time, and children whose provider was Vietnamese or who had an institutional provider were less likely to have been immunized. The odds of being immunized were greater, however, for children who had had at least 1 diphtheria, tetanus toxoid, and pertussis shot, and whose parents had heard about HBV infection, and were married. CONCLUSIONS: The low rates of hepatitis B vaccine coverage among children and adolescents portend a generation which, too old to benefit from infant programs and school entry laws, will grow into adulthood without the protection of immunization. Increased efforts are needed to design successful catch-up campaigns for this population.

Adolescent↗
PubMed2002

Influenza vaccination coverage level at a cystic fibrosis center.

BACKGROUND: Influenza causes substantial morbidity and mortality, particularly in vulnerable populations. Annual vaccination is the most effective means to prevent or attenuate this illness. The vaccine is recommended for patients with cystic fibrosis (CF) older than 6 months, but the degree of adherence with this recommendation is unknown. OBJECTIVES: To determine 1) the vaccination coverage level for the 1997-1998 influenza season in a population of CF patients, and 2) the factors associated with nonadherence with vaccination. DESIGN: Retrospective chart review, a mailed survey, and telephone interviews. SETTING: Intermountain CF Center. This center, accredited by the CF Foundation, delivers health care to affected individuals throughout the Intermountain West. Care of children and adults is based at Primary Children's Medical Center and the University of Utah Hospital, respectively. The adjacent hospitals are comprehensive, tertiary care medical centers on the University of Utah campus in Salt Lake City. Approximately one third of the center's patient population lives in southern Idaho. There are 2 affiliate centers in Idaho, one based in Pocatello/Idaho Falls and the other in Boise. PATIENTS: All patients over 6 months of age on the center's roster. RESULTS: We found documentation of influenza vaccination status in the medical records of 99 patients; 98 who received the vaccine and 1 who did not because of an allergy to egg products. Through the mailed surveys and telephone interviews, we collected data on 236 additional patients. Thus, we report data on 335 (92.5%) of 362 patients on the center's roster. A total of 256 (76.4%) of 335 patients received the influenza vaccine before the 1997-1998 flu season, including 181 (79.4%) of 228 children (<18 years of age) and 75 (70.1%) of 107 adult patients (</=18 years of age). We also analyzed the data assigning all patients to their major site of care, either the Salt Lake parent center or one of the Idaho affiliates. We found no difference in the vaccination rate when comparing parent center to affiliates: 179 (78.2%) of 229 patients at the parent center were vaccinated versus 77 (72.6%) of 106 patients at the affiliates. For the 79 patients who did not obtain the influenza vaccine, the major reasons were: "forgot," "too healthy," "too busy," "worried about the side effects," or "too sick at the time." The unvaccinated group had fewer clinic visits, fewer CF-related hospitalizations, and lived further from the care center than the vaccinated group. To further explore the association between contact with the center and vaccination status, we categorized patients into those who were evaluated in the outpatient clinic and/or hospitalized in 1997 and those who were not. We found that 80.8% of the 281 patients who actually received care at the center during 1997 were vaccinated as compared with only 59.5% of the 42 patients who did not receive care during that year. The timing of clinic visits also appears to be a critical factor. We found that 87.1% of patients who had a visit during the fourth quarter of the year had the vaccination as compared with 64.9% of patients who did not have a fourth quarter visit. A fourth quarter visit remained highly associated with vaccination in a logistic regression analysis, whereas number of clinic visits did not. CONCLUSIONS: The vaccination coverage level in this vulnerable population is higher than other high-risk groups of comparable age. Nonetheless, there is room for improvement. Strategies aimed at increasing patient contact with the CF center, particularly during the fourth quarter of the calendar year, may result in improved vaccination rates. Additional data encompassing a cross-section of CF centers would be helpful in ensuring that influenza vaccination is receiving adequate attention in this patient population. Systematic monitoring of influenza vaccination rates at a national level should be considered as a means of encouraging compliance with this important preventive measure. cystic fibrosis, influenza, vaccination, health care delivery.

Cystic Fibrosis↗
PubMed2003

Transient suppression of atopy in early childhood is associated with high vaccination coverage.

OBJECTIVE: To analyze prevalences of allergic sensitization and atopic disease in relation to vaccination coverage. METHODS: A German atopy risk-enhanced birth cohort of 1314 neonates who were born in 1990 in 5 German cities was studied. A total of 943 children participated in the follow-up visit at 5 years of age. Atopic symptoms and diagnoses (derived from structured interviews), total serum immunoglobulin E, and specific immunoglobulin E against 9 common allergens (CAP Radio-Allergo-Sorbent Test Fluoro-Enzyme Immunoassay) were evaluated. Children were grouped into dose percentiles according to cumulative doses of any vaccine given up to 5 years of age (<10%, 0-11 doses; 10%-50%, 12-14 doses; 51%-90%, 15-20 doses; >90%, 21-27 doses). RESULTS: The cumulative vaccine dose was inversely related to atopic dermatitis prevalences at 6 months (13.8%, 5.2%, 5.1%, and 4.5%), 2 years (16.9%, 10.9%, 7.4%, and 3.7%), 3 years (27.6%, 16.4%, 13.5%, and 4.5%), and 5 years (28.3%, 16.0%, 9.3%, and 11.9%). Asthma followed a similar pattern at age 3 (22.4%, 8.6%, 6.7%, and 6.3%), age 4 (20.0%, 8.6%, 8.9%, and 8.1%), and age 5 (20.8%, 12.6%, 10.3%, and 5.5%). Allergic sensitization rates were inversely related to the cumulative vaccine dose at age 2 (37.5%, 29.1%, 23.8%, and 12.9%). CONCLUSION: Children with a higher vaccination coverage seemed to be transiently better protected against development of atopy in the first years of life.

Asthma↗
PubMed2004

Globalization and multi-spatial trends in the coverage of protected-area conservation (1980-2000).

This study is focused on the global expansion of protected-area coverage that occurred during the 1980--2000 period. We examine the multi-scale patterning of four of the basic facets of this expansion: i) estimated increases at the world-regional and country-level scales of total protected-area coverage; ii) transboundary protected areas; iii) conservation corridor projects; and iv) type of conservation management. Geospatial patterning of protected-area designations is a reflection of the priorities of global conservation organizations and the globalization of post-Cold War political and economic arrangements. Local and national-level factors (political leadership and infrastructure) as well as international relations such as multilateral and bilateral aid combine with these globalization processes to impact the extent, type, and location of protected-area designations. We conclude that the interaction of these factors led to the creation and reinforcement of marked spatial differences (rather than tendencies toward worldwide evenness or homogenization) in the course of protected-area expansion during the 1980--2000 period.

Conservation of Natural Resources↗
PubMed2006

Intentional coverage of a main renal artery during endovascular juxtarenal aortic aneurysm repair in symptomatic high-risk patients.

PURPOSE: To describe the efficacy and morbidity of intentionally covering a main renal artery during symptomatic juxtarenal endovascular aneurysm repair (EVAR). CASE REPORTS: Two patients with symptomatic juxtarenal abdominal aortic aneurysm (AAA) were felt to be at prohibitive risk for open repair. Each underwent EVAR with intentional coverage of 1 main renal artery to achieve adequate proximal hemostatic seal. One patient died at 24 months; the second is symptom-free at 10 months. Both aneurysms initially decreased in diameter. Both patients had increased serum creatinine and required increased therapy for hypertension, but neither required hemodialysis. Renal volume decreased 48.7% and 68.0%, respectively. CONCLUSION: Intentional coverage of a main renal artery during EVAR for a symptomatic juxtarenal aneurysm resulted in effective short-term AAA repair with no need for dialysis. Despite the increased requirement for antihypertensive medications and the observed decline in renal function, this technique provides an option for treatment of this difficult patient subset.

Acute Kidney Injury↗
PubMed1989

[A sampling plan for evaluation of vaccinal coverage].

A sampling project applied in a survey for estimating the vaccination coverage in Araraquara County, S. Paulo State (Brazil), in 1983, is described. A target population of children aged 12-13 months was divided into the strata: children living in private dwellings (i.e. single-family houses) and those living in collective dwelling places (orphanage, asylum). R.H. Henderson and T. Sundaresan's method, proposed by the World Health Organization (WHO) for use by the Expanded Programme on Immunization (EPI) was applied to the first stratum. This method consists of the random selection of 30 partial areas with a degree of probability proportional to the respective partial populations in each area chosen; a starting point ("household") is selected at random within each selected area; the selection of 7 children within each area begins with the first household and continues according to fixed rules. The sample of the first stratum was taken from areas in both urban and rural zones. In the urban zone, after the selection of the area and before the selection of the starting point, an intermediate stage, which consist in the selection of a block with probability proportional to its estimated population, was introduced. A sample was selected form the second stratum with the same sampling fraction used in the first stratum. The ratio-estimate is proposed as the estimator of the vaccination coverage rate and the formula for the calculation of the standard error is presented.

Brazil↗
PubMedDate not supplied

Toward better access to health insurance coverage for U.S. retirees in Mexico.

Many retirees from the United States of America have limited health insurance coverage while living in Mexico. Medicare and Medicaid benefits are not portable to other countries and Medigap (private insurance that supplements Medicare) is very limited. This causes economic and medical hardships and serves as a barrier to retirement to Mexico. Increasing numbers of U.S. retirees will be interested in moving to Mexico in the future because of the climate, the culture, and the lower cost of living. The numbers are increasing as a result of several factors such as aging "baby boomers" and the rapidly growing Mexican-origin population in the U.S.A. who are citizens or permanent residents but would like to return to their communities of origin after working in the U.S.A. There are several policy initiatives that could provide opportunities for improving health insurance coverage for these retirees that could be cost-effective.

Health Services Accessibility↗
PubMedDate not supplied

[Analysis of infant mortality in coverage areas of health centers in Belo Horizonte, Minas Gerais, Brazil (1994-1996)].

Geographic analysis of health conditions highlights regional and intra-urban inequalities. This study aims to identify intra-urban discrepancies in the city of Belo Horizonte, studying the infant mortality coefficients (IMC) in the various areas of the metropolitan area and evaluating their evolution from 1994 to 1996. The study uses data from 1994 to 1996 regarding birth and death records (from the SINASC and SIM registries). It also uses "thematic maps" related to geographic coverage areas of municipal health centers to demonstrate differences in infant mortality coefficients. The empirical Bayesian method was applied to correct possible random fluctuation in IMC due to small and unstable numbers. A 24.4% reduction in the overall coefficient was observed in the city from 1994 to 1996. Decreases also occurred in the health center coverage areas. In 1994, eight areas presented an IMC above 50/1,000, while in 1996 no area reached that coefficient. In 1994, 29 areas presented an IMC from 35 to 50/1,000, as compared to only four areas in 1996. In 1996 there were more areas with IMC below 35/1,000 as compared to 1994. In 1996, more homogeneity was observed in IMC distribution and hence a reduction in intra-urban inequalities.

Bayes Theorem↗
PubMedDate not supplied

[Traffic accidents in a city in Southern Brazil: an evaluation of coverage and quality of data].

The aim of this study was to analyze police coverage and the validity of data on emergency and hospitalization records as well as on death certificates for traffic casualties in Londrina, Paraná State, Brazil. Victims (3,643) of road accidents during the first semester of 1996 were investigated and followed up after 180 days to confirm whether death was due to the accident. Police data recorded only 32.5% of the casualties, the coverage being higher for car occupants (71.6%) and lower for cyclists (8.1%) and pedestrians (24.8%). Agreement was low between original information and that derived from investigation of death certificates (Kappa coefficient 0.10; 95% CI: 0.02-0.17), fair for hospitalization records (Kappa coefficient 0.33; 95% CI: 0.27-0.40), and substantial for emergency records (Kappa coefficient 0.63; 95% CI: 0.61-0.65). Results suggest that police data underestimate the number of traffic casualties and that it is necessary to improve the validity of medical records.

Accidents, Traffic↗
PubMed2003

[Pap test coverage in the city of Pelotas, Rio Grande do Sul, Brazil].

In Brazil, the effectiveness of preventive public heath programs and actions is rarely evaluated. A cross-sectional study was thus performed in a population-based sample focused on several health characteristics of adults living in Pelotas, Rio Grande do Sul, Brazil. The study aimed to measure temporal trends in coverage of Pap smear testing in the city. The authors studied the factors associated with failure of women to submit to a Pap smear. An updated Pap smear was defined as one performed in the previous 3 years. The sample consisted of 1,122 women ages 20 to 69 years, 72.2% of whom had an updated Pap smear, 16.6% of whom were behind schedule for testing, and 11.2% of whom had never had a Pap smear. Risk factors for never having a test were low socioeconomic status and old age. Logistic regression showed an independent effect of social class, low family income, age, skin color, marital status, and no medical appointment in the previous year. However, the effect of chronic diseases disappeared in logistic regression. The authors compare the results of the study conducted in 1992 with the present. Pap smear coverage increased from 65.0% to 72.2% (1992 to 1999/2000) in the city, yet such figures had still not ensured the effectiveness of the program for uterine cervical cancer prevention.

Adult↗
PubMed2004

[Coverage and factors involved in submitting to the Papanicolaou test in the Municipality of São Paulo].

This study estimated Pap smear coverage (at least one test in the lifetime and one in the last three years) among women aged 15 to 49 years old. The study also discusses whether the women received the results of their last test, as well as self-reported reasons for and against submitting to the test. A population-based survey was conducted in the city of São Paulo in 2000 with a randomly selected representative sample of 1,172 women. Among the women who were already sexually active (n = 1,050), 86.1% reported having had at least one Pap smear during their lifetime, and 77.3% had undergone the test in the previous 3 years. Among those who reported having had at least one Pap smear, 87.0% had received the result of the last test. The main reasons reported for having had the last test were: spontaneous demand (55.5%), medical referral (25%), and gynecological complaints (18.2%). The main reasons for never having had a Pap test were: no gynecological problems, embarrassment or fear, and difficulties in accessing health services. Despite high coverage of the Pap test and the fact that the majority of the women had self-reported a spontaneous demand, use of the Pap test was less prevalent among women with the lowest socioeconomic level (and consequently at greater risk of cervical cancer).

Adolescent↗
PubMed2004

[Dengue epidemics and press coverage].

The occurrence of successive dengue epidemics in Brazil highlights the importance of information dissemination by the media. As a sphere for mediation in contemporary societies, the news media produce, expand, and circulate information and meanings that affect people's decisions. In order to contribute to the discussion, this study analyzes coverage by the main daily newspaper in Belo Horizonte, Minas Gerais, Brazil, on dengue epidemics in that State capital from 1996 to 2000, assessing the priority ascribed to the epidemics as news and the various approaches to the disease. Some 446 news stories were selected, classified according to the themes approached in the titles and in the body of the articles. There was a close relationship between the number of news stories and the number of reported dengue cases, with "peaks" in coverage coinciding with outbreaks. According to this study, the news priority for epidemics and the limited space reserved for prevention highlight the need for epidemiological surveillance services to consider strategies to disseminate information through the mass media, aimed at fostering more participatory interventions that would thus be more efficient in the prevention of epidemics.

Bibliometrics↗
PubMed2006

Socio-demographic characteristics, treatment coverage, and self-rated health of individuals who reported six chronic diseases in Brazil, 2003.

The Brazilian World Health Survey, carried out in 2003, included questions about diagnosis of six chronic diseases: arthritis, angina, asthma, depression, schizophrenia and diabetes mellitus. The probabilistic sample of 5,000 adults was selected in 250 census tracts. We analyzed the socio-demographic profile, the coverage of treatment, and self-rated health of the individuals that reported diagnosis of one of these diseases. To control for age and sex, logistic regression models were used. Among the 5,000 participants, 39.1% reported medical diagnosis of at least one of the six diseases. Depression was the most prevalent (19.2%), followed by asthma (12.0%), arthritis (10.5%), angina (6.7%), diabetes (6.2%) and schizophrenia (1.7%). Significant differences by age were found for all diseases, except for asthma. All diseases were more prevalent among women, except angina. Analysis by educational level showed that the diabetes prevalence rate was significantly larger among those with incomplete schooling. Although the six diseases presented different treatment coverage rates, for individuals with diagnosis of any one of the six diseases, the self-rated health was always worst, even after controlling for age and sex.

Adult↗