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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.

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]

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.

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]