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As the United States' population grows via migration and immigration, with this rise in diverse identities, there has been increasing concern regarding disparities for undocumented immigrants living in the U.S. with limited access to the health system. Given the various constraints involving communication and social structures that undocumented immigrants face, a culture-centered approach is drawn on to investigating how this group goes about navigating a dominant health system given their restricted access. I explore co-constructed themes that emerged through conversations with undocumented immigrants, (people without papers as I call them in this work) living in the United States to gain an understanding as to the structural and cultural limitations faced by this group. By doing qualitative semi-structured interviews with local participants living in the South Florida region, I describe the various features of a complex U.S. health system that undocumented immigrants (people without papers) deemed as important obstacles that limit their willingness to interact with official medical spaces. This work draws on narratives and accounts to shed light on the intersection of disparities this group has to overcome in order to consider entering a medical space to receive the treatment they might need. The findings of this article highlighted the structural violence that certain subaltern groups, such as people without papers experience due to their limited access to foundational systems in their environment. [ABSTRACT FROM AUTHOR]

Background: More than 20 million children in the United States lack access to primary health care. Practice Learning: Research shows that students with regular access to physical and mental health services have fewer absences, are more social, less likely to participate in risky behaviors, have improved focus and higher test scores. Implication For School Health Policy, Practice, And Equity: School-based health centers (SBHCs) can be an important, valuable and viable health care delivery option to meet the full-range of primary health care needs of students where they spend the majority of their wake hours, ie, in school. Children in rural and other underserved communities, as well as those underinsured, non-insured, economically challenged, underserved, and the most vulnerable among us are especially at risk. Conclusions: This paper discusses the history, value, and importance of SBHCs from myriad perspectives, including physical and emotional wellbeing, academic and social success, and the promotion of a positive transition to adulthood. In addition, the authors' experiences that resulted in building the first SBHC in the Mid-Hudson Valley Region of New York State are shared. These experiences form the foundation for creating an important roadmap for individuals and school leaders that are interested in bringing a SBHC to their school and district.

In April 2014 the government published a White Paper on Universal Health Insurance, which details the steps towards the implementation of the most radical reform proposals in the history of the Irish health system. The Irish health system currently contains a complex interaction between public and private financing and delivery, leading to a number of inequities, highlighting the need for reform. The government's proposals include changes to the funding, allocation and delivery of health-care resources, and will culminate with the introduction of universal mandatory private health insurance. However, there are a number of potential issues with the reforms, particularly relating to cost and cost containment, the ability of people to pay for mandatory health insurance, the need to strengthen regulatory governance and the need to invest in the provision of services. Wider health-reform issues also need to be considered, irrespective of the funding mechanism proposed. [ABSTRACT FROM AUTHOR]

Background: Medicaid enrollment and retention among eligible populations remains a challenge. Purpose: We assessed health literacy-related features and content of Internet-based state Medicaid enrollment materials and resources. Methods: In February 2021, using established tools, we evaluated paper Medicaid enrollment applications and scope of enrollment resources (on-line enrollment option, toll-free telephone assistance, live chat function, instructional and/or informational audiovisuals). Results: Forty (78.4%) English- and 28 (54.9%) Spanish-language paper Medicaid enrollment applications were available. Overall, document complexity was high as a large volume of information is required to apply for Medicaid coverage. An on-line Medicaid enrollment option was nearly universal. Medicaid government platforms were more likely to provide toll-free telephone assistance (n = 34; 66.7%) than a live chat function (n = 10; 19.6%). Eleven (n = 11; 21.6%) government platforms provided an instructional and/or informational Medicaid enrollment audiovisual resource. Discussion: Our work suggests the need for states to leverage technology in creation of resources to match language and cultural needs of the diverse US population. Translation to Health Education Practice: Access to continuous health insurance coverage, comprehensive clinical care services, and evidence-based health education programming combined are essential in promoting both individual and community health.

What is known about this topic? We discuss a recently published paper that alleges clinicians are causal agents of non-compliant billing of Medicare. What does this paper add? The paper's arguments are partially supported by unreferenced assertions, potential logical fallacies, inaccurate reporting of referenced material and unsubstantiated rhetoric. What are the implications for practitioners? Due to the lack of substantive evidence, it cannot be concluded that clinicians are the causal agents of non-compliant billing of Medicare. [ABSTRACT FROM AUTHOR]

Haze pollution not only affects the quality of economic growth and the image of the government, but also seriously affects public health. With the improvement of climate risk perception, the public is actively seeking all kinds of risk management measures to combat the hazards of haze pollution. The study of the relationship between haze pollution, climate risk perception and the development of commercial health insurance is of great significance to the formulation of haze control policies and the improvement of social security system. This paper attempts to explore the relationship between haze pollution, climate risk perception and commercial health insurance demand by establishing static and dynamic models based on panel data from 31 provinces in China from 2005 to 2022. Also, the spatial spillover effects of haze pollution in different regions on the development of commercial health insurance in other regions are investigated by establishing a spatial Durbin model. It is found that (1) haze pollution has a lagged positive effect on the demand for commercial health insurance; (2) haze pollution has a significant spatial spillover effect on the development of commercial health insurance; (3) this study used Python technology to construct a climate risk perception index, and found that the moderating effect of the residents' perception of climate risk existed significantly, and that the residents might take other measures to manage the risk in the short term, but in the long term, the climate risk perception showed a positive correlation with the level of education. This paper provides implications for government departments and social media to strengthen education and publicity, improve residents' awareness of risk diversification, and deepen the concept of commercial health protection. [ABSTRACT FROM AUTHOR]

The University System of Georgia (USG) has a state-wide initiative aimed at increasing the well-being of faculty and staff by incentivizing a decrease in tobacco product usage by employees covered by a USG healthcare plan. This incentive is positive in that aid in stopping tobacco product usage is offered to each member; and negative in that each member who is a tobacco product user is penalized. A healthcare surcharge is added to the monthly health insurance premium paid by each faculty/staff member for themselves and covered dependents over 18 years of age who are tobacco product users. The current policy considers covered employees and their applicable dependents to be users of tobacco products unless they annually opt-out. This paper includes summaries of the incidence of cigarette and tobacco product usage in the U.S., a summary of USG's policies related to the current tobacco initiative, a brief literature review regarding opt-in and opt-out programs, and a discussion of the possible negative impact of the current USG tobacco use policy. Support is provided for the present tobacco surcharge penalty being either eliminated or its implementation changed, and for the current opt-out default being changed to an opt-in program.

In 2018, West Virginia teachers staged a statewide strike which lasted almost two weeks and included schools across all 55 countywide districts. The main reported strike issues for West Virginia teachers included cuts to their healthcare coverage by the state and relatively low salaries. Prior to the strike, West Virginia teachers ranked 48th in the nation in terms of pay. The West Virginia strike sparked a year-long wave of teacher labor protests across the country, in both predominately rural states and large urban centers. In 2019, West Virginia teachers went on strike again, bringing the movement full circle. In November, 2020, I interviewed Jay O'Neal and Sam Nelson, two teachers involved in the 2018 statewide teachers strike in West Virginia for the National Rural Education Association's Annual Conference and Research Symposium. Jay O'Neal originated the Facebook page in 2017 that served as the hub for organizing activity prior to and during the 2018 strike. O'Neal is a middle school English and social studies teacher; Nelson is a high school English teacher.

This paper measures the effects of subsidies in the Affordable Care Act on adverse financial outcomes using administrative tax data and credit data on financial outcomes. Using a difference-in-differences design with propensity score reweighting, I find that at $100 per capita, ACA premium tax credits and cost-sharing reduction subsidies reduced consumer bankruptcies and severe auto delinquency by 8 percent and 7 percent, respectively, and substantially reduced right-tail delinquent debt and third-party collections. The value of recipients' risk protection against medical debt payments amounts to approximately 16 to 21 percent of the cash costs of the subsidies, while the subsidies provided substantial indirect transfers to external parties.

This paper examines the incidence of the cost burden associated with expanding public health insurance to low-income adults in the context of the Affordable Care Act. Using data from the Medical Expenditures Panel Survey (MEPS), I exploit exogenous variation in Medicaid eligibility rules across states, income groups and time. I find that public insurance eligibility reduced mean out-of-pocket spending by 19.6 percent among targeted households, but it did not causally increase total expenditures among beneficiaries. Rather, Medicaid expansion shifted the burden of payment from eligible households and private insurance (21.5 percent reduction) to taxpayers in the form of public insurance (46.6 percent increase). The efficiency of these public funds can be summarized by a mean Marginal Value of Public Funds of 0.70 in the full sample, 0.99 among households with at least one pre-existing condition, and 1.26 in states with an above-median number of public hospitals.

Objective: Transgender women encounter various barriers to healthcare access and use. Together, these contribute to under-utilisation, delay or avoidance of the healthcare system. This in-depth qualitative phenomenological study aimed to explore perceptions, interactions and experiences with medical and healthcare systems, and identify suggestions for improving healthcare access and utilisation among transgender women. Design/Setting: Fifteen (N = 15) transgender women in Los Angeles County participated in semi-structured telephone interviews. Method: Participants were recruited through emails sent to LGBTQ+ serving institutions, health centres and college campuses. The interview guide covered demographic information, experiences within medical and healthcare setting, interactions and perceptions within clinical settings, and concerns about barriers to healthcare access and utilisation. Results: Healthcare experiences were shaped by interpersonal and structural factors. Four themes were identified: (1) lack of trained and knowledgeable healthcare providers, (2) limitations in healthcare access such as cost and hormone replacement therapy access, (3) implicit bias regarding being misgendered and stereotyped, and (4) explicit bias such as denial of services, inability adding preferred personal information to medical health records, and various aspects of discrimination. Conclusion: Access to knowledgeable healthcare providers was cited as a priority area needing the most attention. Curricula and modules that address social, medical and clinical issues specific to transgender women were suggested for use in the training and continuing education of healthcare professionals. In addition to needs related to patient-provider contact, this paper highlights the broader regulatory and political changes needed to improve the health of transgender women.

This paper examines the debate in the U.S. Senate over the reasons why state governments have decreased funding for higher education. One side believes that federal mandates on states to pay for Medicaid have forced them to reduce spending on higher education. The other side believes that states unwisely reduced taxes, which decreased their revenues and caused cuts to higher education funding. This study finds that important factors regarding revenues and spending are missing from the Senate's debate. Revenues decline for a number of reasons, including the effects of unemployment. Court decisions have required many states to increase spending on K-12 education. As a policy priority, higher education is disadvantaged, in part because lawmakers understand, and perhaps accept, that institutions may increase tuition to replace cuts in appropriations. This acceptance is part of a "grand paradox" between what lawmakers say and what they do regarding higher education. Ultimately, leadership determines states' spending. If governors and legislators have the political will, they can make funding for higher education a priority. [This paper was presented at the Symposium on the Financing of Education presented by the "Journal of Education Finance" at the Oxford Union, Oxford, England on Dec 9, 2014.]

In particular, this paper examines whether insurers with greater opportunities to manage care report significantly better underwriting performance in the fourth quarter relative to other health insurers. Health risk can be defined as the likelihood of a negative health consequence occurring due to a specific event, disease or condition. The first two papers address supply-side issues of health insurance markets by investigating the behaviour and performance of health insurers, either in relation to HMOs or in serving poor individuals. [Extracted from the article]

Background: A robust medical claims review system is crucial for addressing fraud and abuse and ensuring financial viability of health insurance organisations. This paper assesses claims adjustment rate of the paper- and electronic-based claims reviews of the National Health Insurance Scheme (NHIS) in Ghana.Methods: The study was a cross-sectional comparative assessment of paper- and electronic-based claims reviews of the NHIS. Medical claims of subscribers for the year, 2014 were requested from the claims directorate and analysed. Proportions of claims adjusted by the paper- and electronic-based claims reviews were determined for each type of healthcare facility. Bivariate analyses were also conducted to test for differences in claims adjustments between healthcare facility types, and between the two claims reviews.Results: The electronic-based review made overall adjustment of 17.0% from GHS10.09 million (USD2.64 m) claims cost whilst the paper-based review adjusted 4.9% from a total of GHS57.50 million (USD15.09 m) claims cost received, and the difference was significant (p < 0.001). However, there were no significant differences in claims cost adjustment rate between healthcare facility types by the electronic-based (p = 0.0656) and by the paper-based reviews (p = 0.6484).Conclusions: The electronic-based review adjusted significantly higher claims cost than the paper-based claims review. Scaling up the electronic-based review to cover claims from all accredited care providers could reduce spurious claims cost to the scheme and ensure long term financial sustainability. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to present proposed solutions and interventions to some of the major barriers to providing adequate access to healthcare in Kenya. Specific business models are proposed to improve access to quality healthcare in low- and middle-income countries. Finally, strategies are developed for the retail clinic concept (RCC). Design/methodology/approach: Google Scholar, PubMed and EBSCOhost were among the databases used to collect articles relevant to the purpose in Kenya. Various governmental and news articles were collected from Google searches. Relevant business models from other sectors were considered for potential application to healthcare and the retail clinic concept. Findings: After a review of current methodologies and approaches to business and franchising models in various settings, the most relevant models are proposed as solutions to improving quality healthcare in Kenya through the RCC. For example, authors reviewed physician recruitment strategies, insurance plans and community engagement. The paper is informed by existing literature and reports as well as key informants. Research limitations/implications: This paper lacks primary data collection within Kenya and is limited to a brief scoping review of literature. The findings provide effective strategies for various business and franchising models in healthcare. Originality/value: The assembling of relevant information specific to Kenya and potential business models provides effective means of improving health delivery through business and franchising, focusing on innovative approaches and models that have proven effective in other settings.

Based on the unbalanced panel data of Chinese professional health insurance companies from 2011 to 2021, the paper constructs "PW+PCSE" model to empirically investigate the main factors affecting the commercial health insurance surrender in China from the company level. The results show that asset-liability ratio has a significant positive effect on health insurance surrender rate. The value preservation and appreciation rate of capital and R&D expenditure rate both have significant negative effects on health insurance surrender rate. These studies bring important enlightenment for domestic health insurance companies to avoid surrender risk. [ABSTRACT FROM AUTHOR]

This paper explores the experiences of a small group of families in Australia in relation to recent reform to disability policy by way of the National Disability Insurance Scheme (NDIS). Framed in critical disability perspectives of policy implementation research, the paper focuses on the extent to which the scheme articulates inclusive opportunities for children and young people with disabilities, particularly in relation to facilitating access to education. Interview data that illustrate families' expectations of the scheme and latter-day experiences, coercions and negotiations highlight the tensions that exist for scheme participants who draw on its provision to support their education. These first- and second-order policy effects indicate a welcome change to disability support in Australia, though the extent to which the scheme can advance inclusion for people with disabilities is uncertain, given the distance rendered between the policy and its participants and other service systems. The paper concludes with a theoretical discussion based on the analysis of how the NDIS is framed to interrelate with scheme participants and education and how it might be reframed for better outcomes.

Purpose: This paper aims to evaluate Ghana's National Health Insurance Scheme (NHIS) on healthcare utilisation by exploring its heterogeneous effects based on residential status and wealth. Design/methodology/approach: The study used the Ghana Socioeconomic Panel Survey (GSPS) datasets. An instrumental variable strategy, specifically the two-stage residual inclusion (2SRI), was employed to control endogenous NHIS membership. Findings: Generally, the results show that NHIS improves healthcare utilisation (i.e. visits to a health facility and formal care). Concerning the heterogeneous effects of health insurance on healthcare utilisation, the results revealed that NHIS members are more likely to seek care, irrespective of their residence status. The results further indicate that the probability of visiting a health facility and utilising formal care increases for the poorest NHIS participants. Based on these, the authors conclude that NHIS provides equitable healthcare access and utilisation for its vulnerable populations, who are beneficiaries. Originality/value: To the best of the authors' knowledge, this paper is the first to explore the heterogeneous effects of NHIS on healthcare utilisation across residential and income subpopulations. Splitting the dataset by residential status to examine healthcare utilisation inequality is worthwhile. In addition, analysing utilisation in terms of health care type would show whether Ghana's NHIS may be viewed as welfare-enhancing through increased formal health care utilisation. Peer review: The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-05-2023-0330 [ABSTRACT FROM AUTHOR]

Many health insurance markets are organized by principles of regulated competition. Regulators of these markets typically apply risk equalization (aka risk adjustment) and risk sharing to mitigate risk selection. Risk equalization and risk sharing can have various positive and negative effects on efficiency and fairness. This paper provides a comprehensive framework for ex-ante evaluation of these effects. In a first step, we distinguish 22 potential effects. In a second step, we summarize and discuss quantitative measures used for evaluating risk equalization and risk sharing schemes in academic research. To underline the relevance of our work, we compare our framework with an existing framework that was previously used in the Dutch regulated health insurance market. We conclude that this framework is incomplete and uses inappropriate measures. To avoid suboptimal policy choices, we recommend policymakers (1) to consider the entire spectrum of potential effects and (2) to select their measures carefully. [ABSTRACT FROM AUTHOR]

Research on financial literacy seeks to determine whether costly financial mistakes can be avoided. Decisions all consumers face are whether to purchase health insurance, purchase prescriptions, pursue recommended medical testing, and seek medical help for related problems by comparing perceived costs and benefits. Using data from the National Financial Capability Study, this paper provides evidence that financial literacy is a significant determinant in health insurance demand that also reduces the probability of less desirable health-related financial behaviors. [ABSTRACT FROM AUTHOR]

Data reveal that insufficient progress has been made in increasing the number of students with severe disabilities who are educated in general education classes. Agran et al. asked why this is happening and discussed determinants that may be affecting placement decisions that serve to segregate students from their peers. This article is a review of the circumstances that have facilitated the movement of students with both severe disabilities and complex health care needs from hospitals and homes, and into school buildings. It also extends Agran et al.'s discussion to placement decisions that may be affecting this specific group of students. [For "Why Aren't Students with Severe Disabilities Being Placed in General Education Classrooms: Examining the Relations among Classroom Placement, Learner Outcomes, and Other Factors," by Agran et al., see EJ1246688.]

Increasing insurance fraud has resulted in the loss of large amounts of money, making it difficult to expand insurance coverage and scale. This phenomenon is particularly acute in the field of health insurance. Medical insurance fraud is the falsification of medical records to obtain medical insurance funds or medical insurance benefits. Therefore, effective detection of health insurance fraud is of great importance for the rational use of health insurance funds. To address the frequent violations and frauds in health insurance, this paper proposes a keyword combination-based approach for health insurance fraud detection. First, a medical dictionary is built by TextRank to segment the surgical procedure text and extract the surgical keywords, then, the synonyms corresponding to each keyword are extracted from the electronic medical record data to form a keyword combination pattern as the final detection rule, and finally, a medical insurance fraud detection model is built on this basis. In this paper, data on acute myocardial infarction and unstable angina were selected for examination, with 1371 and 1787 cases, respectively. The performance of the model was evaluated by the coverage rate and compared experimentally with the TF-IDF and LDA algorithms. The experiments also prove the efficiency and advancedness of the algorithm in this paper. In the case of acute myocardial infarction, the method in this paper improved the coverage rate by 23.77% and 9.4% compared with the TF-IDF and LDA methods respectively. In the case of unstable angina, the coverage of the method in this paper was improved by 20.21% compared to both TF-IDF and LDA methods. [ABSTRACT FROM AUTHOR]

As the healthcare industry has evolved over the years, so too has the administration of healthcare organizations. The signing into law of the Patient Protection and Affordable Care Act (ACA) has brought additional changes to the healthcare industry that will require changes to the healthcare administration curriculum. The movement toward a vertically integrated delivery system for healthcare has demanded that healthcare executives have a new set of skills and competencies. These competencies include management skills across hospitals, ancillary providers, physician practices, ambulatory settings, as well as skills in risk management and quality. Healthcare organizations can transform healthcare delivery through the power of technology and systems oriented care. This will require a new type of healthcare executive with new skill sets. This paper examines the skill sets of leaders of some of the leading integrated delivery systems in the United States through key interviews with twelve top executives. Based upon those interviews, c-suite executives in large healthcare systems were surveyed to identify the core competencies of the successful healthcare executive of the future and the graduate education requirement needed to achieve those competencies. The results of the study are used to provide suggestions on how the curricula of healthcare administration programs can be revamped.

Healthcare is a critical area where blockchain technology (BT) is being heralded as a potential game-changer for facilitating secure and efficient data sharing. The purpose of this review is to examine BT applications, performance challenges, and solutions in healthcare. To begin, This review paper explores popular blockchain networks for data exchange, encompassing both public and permissioned platforms, such as Ethereum and Hyperledger Fabric. This paper analyzes the potential applications of BT's decentralized, immutable, and smart contract capabilities in healthcare settings, including secure and interoperable health data exchange, patient consent management, drug supply chain oversight, and clinical trial management. The healthcare industry might greatly benefit from the increased privacy, transparency, and accessibility that these technologies provide. Despite BT's promising medical uses, the technology is not without its drawbacks. High energy consumption, throughput, and scalability are all concerns. We wrapped up by discussing the solutions that have been implemented, including consensus processes, scalability measures like sharding, and off-chain transactions that are designed to mitigate the drawbacks. [ABSTRACT FROM AUTHOR]

The aim of the paper is to propose a new comprehensive retirement insurance solution (CRIS) that, by offering appropriate modules, can be flexibly adapted to customers' needs during the accumulation of funds and entitlements and during retirement. Technically, the product is life-insurance-based and includes insurance for sickness and in-capacity, long-term care (LTC), work activation expenses, hospital stays, and tontine and Luxembourg policies. Due to consumers' changing expectations and needs, the technical dimension of this solution is based on a three-layer insurance product in which individual parts of the protection are supplemented by several additional benefits (types of assistance) that improve the quality of life of insurance participants and allow the ongoing use of the product. The basis for considering such a new insurance product is the theory of change (ToC), which makes it possible to build considerable flexibility into such a solution. A SWOT analysis was used to position the proposed solution in relation to other insurance products and social security offered by the state. [ABSTRACT FROM AUTHOR]