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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]

Objective: When prescribed with opioids, sedative-hypnotics substantially increase the risk of overdose. The objective of this paper was to describe characteristics and trends in opioid sedative-hypnotic co-prescribing in a network of safety-net clinics serving low-income, publicly insured, and uninsured individuals. Methods: This retrospective longitudinal analysis of prescription orders examined opioid sedative-hypnotic co-prescribing rates between 2009 and 2018 in the OCHIN network of safety-net community health centers. Sedative-hypnotics included benzodiazepine and non-benzodiazepine sedatives (eg, zolpidem). Co-prescribing patterns were assessed overall and across patient demographic and co-morbidity characteristics. Results: From 2009 to 2018, 240 587 patients had ≥1 opioid prescriptions. Most were White (65%), female (59%), and had Medicaid insurance (43%). One in 4 were chronic opioid users (25%). During this period, 55 332 (23%) were co-prescribed a sedative-hypnotic. The prevalence of co-prescribing was highest for females (26% vs 19% for males), non-Hispanic Whites (28% vs 13% for Hispanic to 20% for unknown), those over 44 years of age (25% vs 20% for <44 years), Medicare insurance (30% vs 21% for uninsured to 22% for other/unknown), and among those on chronic opioid therapy (40%). Co-prescribing peaked in 2010 (32%) and declined steadily through 2018 (20%). Trends were similar across demographic subgroups. Co-prescribed sedative-hypnotics remained elevated for those with chronic opioid use (27%), non-Hispanic Whites (24%), females (23%), and those with Medicare (23%) or commercial insurance (22%). Conclusions: Co-prescribed sedative-hypnotic use has declined steadily since 2010 across all demographic subgroups in the OCHIN population. Concurrent use remains elevated in several population subgroups. [ABSTRACT FROM AUTHOR]

This paper summarizes emerging practice and research issues in the health insurance industry. We provide an industry overview, epitomize business analytics applications, and outline current and emerging problems of interest to key stakeholders and researchers in information systems, operations management, and healthcare management. Specifically, we focus on three areas of research that are of importance to the health insurance industry as well as the healthcare system: (i) management and evaluation of intervention programs, (ii) creation of effective provider networks, and (iii) emerging issues such as the impact of a pandemic, patient communication and steering, and technological innovations in health care. We lay out brief details of how each of these problems can be formulated, where the data can be acquired (public and/or proprietary data sets), and provide guidance for solving them. For several of these problems, we provide models that span causal modeling, predictive modeling, and prescriptive modeling. [ABSTRACT FROM AUTHOR]

This paper examines the role of universal healthcare on patient choice and quality of care. Lack of health insurance is a leading contributor to emergency department (ED) visits from the uninsured. Using a natural experiment from Massachusetts, we follow previously uninsured individuals over time—both before and after the implementation of universal healthcare—to study the effects of insurance availability on their healthcare seeking behavior. We find that the availability of health insurance has a significant impact on the type of healthcare sought by the previously uninsured. Specifically, individuals are less likely to continue visiting the ED and instead more likely to choose hospital inpatient and outpatient services. We find that frequent fliers and patients with chronic conditions, who are both known to account for a substantial share of healthcare costs, exhibit heterogeneity in this behavior. Finally, we examine the effect of the policy on quality of care, as measured by short‐term ED revisits. Although the overall revisit rates remain unchanged, frequent ED users and chronic patients experience a decline in short‐term ED revisits. With key features of the Affordable Care Act being frequently criticized for repeal, understanding how these changes influence patient choice and quality of care is significantly policy relevant. [ABSTRACT FROM AUTHOR]

Steady increases in the cost of medical care, coupled with a rise in the fraction of workers who lack medical insurance, create incentives for workers who are injured off-the-job to file Workers' Compensation claims. Many analysts have interpreted the high rate of Monday injuries - especially hard-to-monitor injuries like back strains-as evidence of such claims. The analysis in this paper, however, which uses data on "first reports" of injuries filed with the Minnesota Department of Labor and Industry between 1985 and 1989, indicates that workers with low probabilities of medical coverage are no more likely to report a Monday injury than are other workers. Moreover, employers are no more likely to challenge the Monday injury claims of workers with low medical coverage rates than the claims filed by workers with high coverage rates. [ABSTRACT FROM AUTHOR]

One of the costs borne by workers changing jobs is the income loss associated with forfeited fringe benefits, including nonvested pensions, paid vacation and sick leave, group medical and life insurance coverage, and possibly profit-sharing and stock-ownership programs. This paper uses longitudinal information on a representative sample of workers to derive empirical estimates of the costs of changing jobs that are attributable to the loss of such benefits. Employer-sponsored pension and health insurance plans prove to be the most important quantitatively. [ABSTRACT FROM AUTHOR]

In a widely cited 1995 paper, Aaron Yelowitz concluded that Medicaid eligibility expansions for children were associated with increased labor force participation and reduced welfare participation among single mothers. The authors of the present study, using data from the 1988-96 Current Population Surveys, re-examine the evidence presented by Yelowitz. They find that Yelowitz's results resulted from two factors: he imposed a restriction on the parameter estimates not predicted by theory and rejected in the data, and he used only one of two income tests that families must pass to be eligible for welfare. The authors conclude that there is no evidence detectable in the CPS data of a relationship between welfare or labor force participation and the Medicaid income limits. [ABSTRACT FROM AUTHOR]

Federal legislation passed in the late 1980s greatly expanded the Medicaid program to include children in families with incomes at and above the poverty threshold, regardless of family structure. Using March Current Population Survey data, the author evaluates how the expansions affected private and public insurance coverage levels across the income distribution. Estimates of the extent of take-up of public coverage and substitution of private coverage are used to generate distributions of coverage under two counterfactual situations: absence of expansions, and absence of substitution. The results indicate that the expansions had an equalizing effect on coverage levels across the lower five deciles of the income distribution between 1988 and 1995. In their absence, coverage would have fallen significantly in the third through fifth income deciles. Also, if all of the increased Medicaid enrollment had come from the uninsured population, inequality in coverage levels would have decreased even further. [ABSTRACT FROM AUTHOR]

Using data from an extensive sample of insurers' claim reports for the years 1979-87, the author evaluates the effectiveness of medical cost containment policies traditionally used in workers' compensation--namely, fee schedules and limits to choice of provider. She also examines the indirect impact on medical benefit costs of rules governing the availability and amount of workers' compensation income benefits. Contrary to the expectations of policy makers and the findings of some other researchers, the results of this paper suggest that medical cost containment policies and statutory provisions regulating levels of, and eligibility for, indemnity benefits do not effectively contain medical costs. [ABSTRACT FROM AUTHOR]

It is widely hypothesized that health insurance deters job mobility because of imperfections in the labor and health insurance markets. This paper describes the nature of the welfare loss attributable to such "job-lock" and reviews several studies that empirically test the job-lock hypothesis. The authors find that estimates of the magnitude and importance of job-lock vary. Studies that support the job-lock hypothesis typically report a 20% to 40% reduction in mobility rates, depending on worker marital status and gender. Their own estimates suggest that although job-lock is present in the labor market, the proportion of workers affected and the magnitude of the welfare loss are less than generally supposed. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to examine the effects of political ideology and self-interest on the attitudes of medical students toward national health insurance. Previous empirical studies of the relative importance of ideology and self-interest in explaining attitudes and behavior have been conducted on general population samples. This is the first empirical test of the effects of these factors on the attitudes of professionals in general and of medical students in particular toward a policy issue which is important to their material interests, but which evokes ideological responses at the same time. The findings show that political ideology as well as objective and subjective self-interest are independent dimensions. Both factors are related strongly to medical students' attitudes toward national health insurance. Their relative strength varies considerably with the salience of the issue at hand. Almost uniformly, political ideology has a more pronounced impact on attitudes than does objective self-interest. The differences between the effects of political ideology and of subjective self-interest, however, are not always substantial or significant. [ABSTRACT FROM AUTHOR]

This paper empirically examines the reliability and validity of three measures of the health of the elderly: an index measuring the ability to perform the activities of daily living without help (Index of Living Skills), an index measuring functional disability (Shanas's Index of Disability), and an index measuring chronic health conditions (the index subsequently used in the U.S. Health Insurance Study). The data involve a random sample of elderly persons living in Manitoba in 1971. The analyses used -- correlational matrices, factor analyses, internal consistency reliability coefficients, and construct validity -- are reported separately for those living in conventional housing in the community, in subsidized housing, and in institutions providing some form of medical care. The results suggest that the Index of Living Skills measures not one but two underlying constructs (heavy and light tasks), Shanas's Index of Disability is reliable and valid when used among those living in the community and in institutions but not among those in subsidized housing, and the index of chronic conditions is relatively unreliable among all three groups of elderly persons. [ABSTRACT FROM AUTHOR]

Most migrant workers in mainland China are officially covered by the New Rural Cooperative Medical System (NRCMS), a rural health insurance system that operates in their home communities. The NRCMS and the system of household registration (hukou) are tightly linked and systemicaOy interdependent institutions. Migrant workers have difficulties benefitting from this social protection because it remains spatially separated from them. Only a minority have access to urban health insurance systems. This paper sheds light on the institutional origins of the coverage problem of migrant workers and examines crucial policy initiatives that attempt to solve it. In the context of the ongoing hukou reforms, these policies aim to partially dissolve the systemic interdependence of hukou and health insurance. While the policies provide feasible, yet conflict-prone, solutions in short-distance and concentrated bilateral migration systems, covering migrants who cross provincial boundaries remains a challenge. [ABSTRACT FROM AUTHOR]

Context: Public health policies are designed for specific subsets of the population. Evidence that a policy is effectively designed should be based on whether it effectively addresses its mission. A critical factor is determining whether utilization patterns reflect the mission and the efficacy of public health policies, particularly during early stages of implementation. We assert that utilization patterns can be effectively assessed using geographic information systems (GIS).Objective: This paper uses the Silver Alert program, a recently implemented public health policy, as a case for how and why GIS can be used to examine utilization patterns.Design: GIS are employed to visualize and spatially analyze a new health policy--North Carolina's Silver Alert policy. We use visualized data and spatial statistics to assess utilization patterns and mission adherence.Results: Results show disproportionate utilization patterns of the Silver Alert policy. In particular, an outstanding number of Silver Alerts were used in Wake County and its surrounding counties, which are both the political and media center of North Carolina. Other counties, including populous counties, had few if any alerts.Conclusion: Findings suggest that the North Carolina's Silver Alert policy needs to be adjusted to more effectively address its mission. We identify several factors that need further examination prior to a statewide evaluation. From this case study, we propose ways future programs, particularly the introduction of the Affordable Care Act (ACA) in 2014, might use GIS to examine utilization patterns as a means to better understand whether and in what ways the health care needs of the public are being met with such a policy. [ABSTRACT FROM AUTHOR]

The author analyzes data from the National Medical Expenditure Survey of 1987 to measure the importance of "job lock"--the reduction in job mobility due to the non-portability of employer-provided health insurance. Refining the approach commonly used by other researchers investigating the same question, the author finds insignificant estimates of job lock; moreover, the confidence intervals of these estimates exclude large levels of job lock. A replication of an influential previous study that used the same data source shows large and significant job lock, as did that study, but when methodological problems are corrected and improved data are used to construct the job lock variables, job lock is found to be small and statistically insignificant. [ABSTRACT FROM AUTHOR]

Using data from the 1969-79 Retirement History Study, the 1977 National Medical Care Expenditure Survey, the 1983-86 Survey of Consumer Finances, and the 1988 Current Population Survey, the authors analyze, with a structural retirement model, the effect on retirement of employer-provided health benefits. Such benefits, they find, tend to delay retirement until the age of eligibility and afterward to accelerate it. The net effect is small: employer-provided health benefits lowered male retirement age by only about 1.3 months. Valuing health benefits at the price of private health insurance to unaffiliated men, rather than at the cost to employers, increases the effect. Ignoring retiree health benefits in retirement models creates only a small bias. [ABSTRACT FROM AUTHOR]

The aims of this paper are to analyze the role of medical and health professions in creating and establishing the disability category. We also explore how the diagnosis, measurement, and treatment of disability have contributed to stigmatization and promoted social, political and economic inequality. Theories from a variety of disciplines are used to examine the ways that medicine and the health-related professions have contributed to the oppression of people with disabilities, including the maintenance of a 'medical/knowledge power differential,' reinforcement of the 'sick role,' and objectification of people with disabilities. We also explore opportunities for empowerment versus 'sick role' status. The medical and health professions are uniquely positioned to promote the empowerment of people with disabilities as active partners in their own health care. Replacing the biomedical model of disability with a socio-political model that prioritizes disease/health care management, wellness and prevention of further disability as opposed to treatments aimed at curing disability could facilitate the empowerment process. [ABSTRACT FROM AUTHOR]

This literature review broadly examines disability in Alzheimer's disease (AD). The paper addresses the various types of disability in AD, as well as the presumed causes and the economic and social costs of such disability. The influence of various types of treatment of disability, particularly pharmacological is addressed, as are directions for future research. [ABSTRACT FROM AUTHOR]

The debate over the impact of the new Medicare prescription drug benefit (Part D) has intensified in anticipation of its implementation. This paper contributes additional information related to the effect of different types of prescription drug coverage plans on use and expenditures among elderly Medicare beneficiaries.Cross-sectional design using data from the 2002 Medical Expenditures Panel Survey (MEPS). The two dependent variables were (1) prescription drug use and (2) expenditures. The main independent variable was the type of drug insurance (Medicare FFS only [no Rx insurance], Medicare FFS + Rx insurance and Medicare HMO). Bivariate and multivariate analyses were used to test the effect of insurance type, and beneficiaries' characteristics, on likelihood and level of drug use, as well as expenditures. The findings showed that average total drug expenditures among Medicare FFS enrollees who had Rx insurance (non-HMO) were higher ($182.51) than that of Medicare FFS enrollees with no Rx insurance. In addition, the former group had a higher likelihood (any use) of using prescribed medications. On the other hand, no differences in the likelihood of use were detected between Medicare HMO and Medicare FFS (no Rx insurance) enrollees. However, Medicare HMO enrollees had a higher level of drug use. In conclusion, The differences in drug use and expenditures by insurance type imply that each party (Medicare, Medicare Advantage plans, employers) will have a different set of dis/incentives for involvement in Medicare Part D. [ABSTRACT FROM AUTHOR]

This paper shows that regulatory actions can work as an instrument to correct the shortcomings of the private health insurance market. However, despite rules that defend both competition and consumer rights, these actions can, paradoxically, bring about a more marked concentration of the market if the power of the oligopolies is not challenged. To critique this sort of management, we first discuss the political context in which the Agência Nacional de Saúde Suplementar -- ANS (National Supplementary Health Agency) arose, and describe the nature of the economic crisis facing the market. Considering these issues, we suggest an alternative proposal, in which the Agency would play a key role in overcoming the crisis, particularly by supporting public health principles and reducing the price of health insurance. We finally argue for the institutional reform of the market, restoring the meaning of the Agency's rules and preventing the ANS from falling under the power of the oligopolies. [ABSTRACT FROM AUTHOR]

Although the National Health System (NHS) is the main healthcare financing body in Spain, an increasing share of the population 'goes private' by obtaining supplementary private healthcare insurance (PHI). Qualitative research is very limited and empirical studies hardly ever provide us with what lies behind the figures. This paper seeks to examine qualitative and quantitative evidence on the individual's motives for the purchase of PHI. We undertook two focus groups together with a representative survey containing open-ended and closed questions among a sample of the Catalan population. Our findings indicate a high degree of heterogeneity in the motives for going private, ranging from the already acknowledged 'quality motive' to simple tradition. A certain share of the population reveals 'captivity' and satisfaction towards the NHS, as well as being unable to afford private alternatives. Furthermore, risk aversion and income was significantly higher for those purchasing PHI. [ABSTRACT FROM AUTHOR]

It has been an important financial issue in the U.S. Medicare expenditures that health care expenses of Medicaid-Medicare dual eligibles (MMDE) are much higher than those of Medicare only beneficiaries (MOB). This paper compares health care use and health status of MMDEs and MOBs who are either Afro-American or white recipients. Using total health care use information from the Medical Expenditure Panel Survey (MEPS) 2000, we find that the proportion of dual eligibles with chronic health conditions is higher by 4% than that of the Medicare only beneficiaries and that dual eligibles make more frequent uses of various health care services. The number of office-based physician visits and outpatient physician visits are higher for Afro-American dual eligibles than white dual eligibles. This finding seems to be contributed to by relatively high medical needs among dual eligibles. Higher utilization of agency-related home health services among Afro-American dual eligibles than among white dual eligibles is considered as a consequence of different ethnicity-specific responses to insurance coverage. [ABSTRACT FROM AUTHOR]

The United States is the only western industrialized nation that fails to provide universal coverage and the only nation where health care for the majority of the population is financed by for-profit, minimally regulated private insurance companies. These arrangements leave one-sixth of the population uninsured at any given time, and they leave others at risk of losing insurance as a result of normal lVe course events. Political theorists of the welfare state usually attribute the failure of national health insurance in the United States to broader forces of American political development, but they ignore the distinctive character of the health care financing arrangements that do exist Medical sociologists emphasize the way that physicians parlayed their professional expertise into legal, institutional, and economic power but not the way this power was asserted in the political arena. This paper proposes a theory of stakeholder mobilization as the primary obstacle to national health insurance. The evidence supports the argument that powerful stakeholder groups, first the American Medical Association, then organizations of insurance companies and employer groups, have been able to defeat every effort to enact national health insurance across an entire century because they had superior resources and an organizational structure that closely mirrored the federated arrangements of the American state. The exception occurred when the AFL-CIO, with its national leadership, state federations and union locals, mobilized on behalf of Medicare. [ABSTRACT FROM AUTHOR]

The article discusses American health care and health care reform. This paper explains the USA health care system. The complexities of US health care system and that of the UK system do not have the same solutions but the problems seem to have many similarities. In this paper, the problems of the American health care are presented and suggested reforms.

This paper considers the meaning of minority group status for the Hispanic population of the United States regarding access to medical care. A review of the relevant literature raises a number of questions concerning determinants of medical care utilization for Hispanics. They are explored using data from a national survey of health care utilization that oversampled the Hispanic population of the southwestern United States. Some indicators suggest that limited access to medical care for Hispanics in this region is associated with low levels of income, education, and health insurance coverage. Some implications of the findings for future research on Hispanics' access to medical care are presented. [ABSTRACT FROM AUTHOR]

This paper develops and tests a model of the health services delivery system based on an examination of the interrelationships among patient and provider variables (treated as exogenous) and access, utilization, continuity, quality, and satisfaction with medical care services (treated as endogenous). The model is tested using data collected from 106 hypertension patients enrolled in the Seattle Prepaid Health Care Project during the period February 1, 1971, through June 30, 1973. Several findings of both sociological and public policy interest emerged. Perceived access to care was among the most important predictors of patient satisfaction: patients from larger families were less satisfied with their care and experienced poorer outcomes of care; patients receiving care from independent fee-for-service practitioners experienced better outcomes than patients receiving care from prepaid group practice providers, even though the latter met a higher percentage of indicated criteria for care; and there was no relationship between perceived access to care and annualized visits. Several important interaction effects involving the nature of the provider system were predicted and supported by the data. The findings are viewed as a first step in the development of a "middle-range" theory of health services delivery systems. [ABSTRACT FROM AUTHOR]

Commercial insurance is an important risk management tool whose demand is affected by psychological factors. Music can promote consumption by evoking non-random emotional and behavioral responses in consumers . Using data from the China Comprehensive Social Survey, we examined the impact of music on commercial insurance purchase behavior using a probit model, an instrumental variable, propensity score matching, and other methods. The results indicate that music can significantly increase the probability of residents purchasing commercial medical insurance and endowment insurance by 2.569% and 1.869%, respectively. Regarding the mechanism, music encourages residents to purchase insurance by increasing their general cognition, risk cognition, insurance cognition, and ability to manage risk. Furthermore, an analysis of heterogeneity shows that music plays a greater role in promoting the aforementioned behavior of residents with lower levels of education, lower frequencies of social interaction, internet usage, an agricultural household registration, and of residents with jobs. [ABSTRACT FROM AUTHOR]

Telepsychiatry is a cost-effective alternative to in-person psychiatric consultations. The COVID-19 pandemic brought about a sharp spike in the utilization of telepsychiatry due to ongoing restrictions on gatherings and traveling. In recognition of the importance of telemedicine in general, and telepsychiatry specifically, telemedicine practice guidelines and telepsychiatry operational guidelines have been released. Due to the rising trend in telemedicine, the Insurance Regulatory and Development Authority of India (IRDIA) incorporated teleconsultation health insurance coverage at a level on par with regular in-person consultations. In contrast, in the United States of America, private insurance coverage for telepsychiatry has been in vogue for some time. In this paper we draw comparisons between India and the United States on telepsychiatry and health insurance. We compare the evolving regulatory policies of these two countries in relation to existing insurances plans that are available, the challenges in implementation of new regulations and the possible ways to overcome the challenges to make telepsychiatry affordable to all. [ABSTRACT FROM AUTHOR]

Universal health insurance is widely believed to be a key strategy for improving health services. However, few studies have examined whether it increases the use of modern contraceptives. The purpose of the present research is to determine whether the policy of incorporating family planning services into the national health insurance policy in Indonesia (Jaminan Kesehatan Nasional [JKN], implemented in 2016) has led to an increase in the use of modern contraceptives. The data were obtained from the 2019 Government Performance and Accountability Survey (GPAS; T otal = 46,220 married women aged 15–49 years). The findings show that women who are covered by the health insurance scheme for non-poor families (JKN non-PBI) are 19.12 times more likely to use modern contraceptives than women who are uninsured. Women who are covered by health insurance scheme for poor families (JKN PBI) are 17.04 times more likely to use modern contraceptives than those who are uninsured. These results are robust against predisposing, enabling and need factors associated with modern contraceptive uptake (i.e., education, family economic status, religion, knowledge of modern contraception, age at time of first marriage, perception of the ideal number of children, number of children born alive, and area of residence). The findings suggest that the government should expand health insurance benefits in order to increase the uptake of modern contraceptives, particularly among disadvantaged group within communities. [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue, including one by Alan Monheit and Philip Cooper on company-based health insurance plans and another by Lynn Karoly and Jeannette Rogowski on group health insurance for retirees.

Objectives: The primary aim of this study was to define the impact of socioeconomic factors, such as national area of deprivation index (ADI) and medical insurance type, on the access to orthopaedic care after an ACL rupture. The secondary aim was to determine if these variables, national ADI and medical insurance, were associated with second ACL injury after primary ACLR. We hypothesized that patients with a greater national deprivation index and Medicaid insurance will have less access to specialized care and an increased risk of re-injury. Methods: An IRB approved retrospective study was conducted evaluating 339 patients that underwent ACL reconstructions between November 2015 and August 2018 by 3 sports medicine fellowship-trained orthopaedic surgeons. Patients undergoing primary ACL reconstruction were included. Demographic and surgical characteristics data were obtained via chart review and telephone interviews. National ADI percentile was obtained utilizing the Neighborhood Atlas Website and the patients' home addresses. The relationship between national ADI percentile and care characteristics (e.g., time to specialized care) were investigated using Spearman's rank correlation coefficients (p) while the association between patient and care characteristics, and second ACL injury were investigated using multivariable logistic regression. Results: A total of 339 patients met inclusion criteria and had complete datasets for all variables of interest. Participants had an average age of 23 ± 7.4 yrs. 55.8% of the patients were males and identified themselves as: White 45.7%, African American 14.5%, Asian 11.8%, Hispanic 7.7% and Other 21.3%. Patients with a greater national ADI percentage took longer to seek specialized care from time of injury (p = 0.141, p = 0.009) as well as to undergo surgery from time of injury (p = 0.183, p < 0.001). Individuals who utilized Medicaid insurance had significantly greater odds of experiencing a second ACL injury (OR = 3.079, p = 0.023) when compared to individuals who utilized commercial insurance. National ADI percentile (p = 0.208), time from injury to specialized care (p = 0.342), and time from specialized care to surgery (p = 0.051) did not significantly contribute to the model. Conclusions: Lower socioeconomic status adversely affects timing of care and re-injury rates following an ACL injury. Patients with a greater national ADI percentage took significantly longer to seek specialized care and obtain surgery following ACL injury. Patients utilizing Medicaid insurance were more likely to sustain a re-injury following ACL Reconstruction. Future studies should look at factors that impede access to care and adversely affect post-operative outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To reduce the number of new HIV infections and improve HIV health care outcomes, the social conditions in which people live and work should be assessed. The objective of this study was to describe linkage to HIV medical care by selected demographic characteristics and social determinants of health (SDH) among US adults with HIV at the county level. Methods: We used National HIV Surveillance System data from 42 US jurisdictions and data from the American Community Survey to describe differences in linkage to HIV medical care among adults aged ≥18 with HIV infection diagnosed in 2017. We categorized SDH variables into higher or lower levels of poverty (where <13% or ≥13% of the population lived below the federal poverty level), education (where <13% or ≥13% of the population had

Objectives:Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is recommended in patients with white coat hypertension (HTN) by national guideline, but was poorly utilized, and is available only in very limited subspecialty clinics. We aim to examine the feasibility and utility of ABPM in a primary care setting in the diagnosis and management of white coat HTN including the implementation and modification of antihypertensive therapy. Methods: Patients who have elevated blood pressure in clinic office but normal blood pressure readings at home are eligible for 24-h ambulatory BP monitoring. We analyzed data from patients who were suspected to have white coat HTN in the last 2 years underwent ABPM in our practice. Results: Among 68 patients, 54 patients met the selection criteria. ABPM showed that 13 patients had normal BP (24%), while 41 patients (76%) had persistent HTN. Among these patients with persistent HTN, 28 patients had intervention including 24 patients prescribed with new anti-hypertensive medication or medication increase, 3 patients prescribed with additional lifestyle modification and one started CPAP.13 patients with slightly elevated BP (133/77 for average daytime BP) didn't have medication adjustment. Conclusion: ABPM has substantial utility in the diagnosis and management of white coat HTN in a primary care setting. [ABSTRACT FROM AUTHOR]

Background: The sustainability of the National Health Insurance (NHI) program heavily relies on the premium of its member. The negligence of a large number of members at pay the premium lead to the failure of the Social Security Agency for Health (SSAH) to deliver its services. This study aims at analyzing important factors that influence the sustainability of premium payment of NHI's self-enrolled members in the Jakarta Greater Area. Design and methods: This study performed an econometric analysis from the panel and the same respondent's data in 2015 and 2017. The population of the study was NHI's self-enrolled members who lived in the City of Jakarta, Bogor, Depok, Tangerang, Bekasi, (Jakarta Greater Area) and it represents the urban area of Indonesia. The ordinal logistic regression model was used to determine the type of sustainability NHI premium payment. Results: The survey shows that around 28.3% of self-enrolled members do not pay the NHI insurance premium regularly. Applying ordered logit this study statistically confirms that age of household head, income per month, never experience economic hardship, 1st/2nd class registration, and benefits of SSAH are positively correlated with compliance rate to pay NHI insurance premium. Whereas tobacco consumption, health-seeking behavior, and the 2016 increase of premium are negatively correlated with regular premium payment. Conclusions: This study calls for policy intervention to improve compliance of premium payment such as i) massive promotion of insurance literacy and benefits of insurance through a health professional, internet, and government officer; ii) expanding auto-debit and installment premium payment; iii) incentive for paying premium regularly and not smoking; and iv) improving access and quality of health services. [ABSTRACT FROM AUTHOR]

Objectives: Rural residents comprise approximately 15% of the United States population. They face challenges in accessing and using a health care system that is not structured to meet their unique needs. It is important to understand rural residents' perceptions of health and experiences interacting with the health care system to identify gaps in care. Methods: Our team conducted focus groups with members of the Michigan Farm Bureau during their 2019 Annual Meeting. Topics explored included resources to manage health, barriers to virtual health care services, and desired changes to localized healthcare delivery. Surveys were used to capture demographic and internet access information. Conclusion: Analysis included data from 2 focus groups (n = 14). Participants represented a wide age range and a variety of Michigan counties. The majority were full-time farm owners with most—93% (n = 13)—reporting they had access to the internet in their homes and 86% (n = 12) reporting that their cellphones had internet capabilities. Participants identified challenges and opportunities in 4 categories: formal health care; health and well-being supports; health insurance experiences; and virtual health care. Conclusion: The findings from this study provide a useful framework for developing interventions to address the specific needs of rural farming residents. Despite the expressed challenges in access and use of health care services and resources, participants remained hopeful that innovative approaches, such as virtual health platforms, can address existing gaps in care. The study findings should inform the design and evaluation of interventions to address rural health disparities. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: Despite compelling evidence of clinical and economic benefits, adherence to colorectal cancer (CRC) screening remains low. Increasing public awareness through various outreach methods may improve screening uptake. The objective of this study was to evaluate the uptake of non-invasive multi-target stool DNA (mt-sDNA) by different outreach methods in an average-risk employer population. Methods: This retrospective observational study included CRC screening-eligible individuals aged ≥50 years insured by the Metropolitan Nashville Public Schools (MNPS) employee healthcare plan. The study intervention arms included population-based outreach and office visit-based interaction. The mt-sDNA completion rate (proportion of individuals who return the mt-sDNA kit after consenting to have it shipped to their home), proportion of patients who performed follow-up colonoscopy after a positive test, and time to follow-up colonoscopy were assessed. Results: A total of 167 mt-sDNA kits were shipped to eligible participants (aged 50-64 years) in the population-based outreach arm. In the office visit-based interaction arm, a total of 132 mt-sDNA kits were shipped to eligible participants (aged ≥50 years). The mt-sDNA completion rate was significantly higher for office visit-based interaction as compared to population-based outreach (76.8% vs 53.5%; P <.001) among those aged 50 to 64 years. While all patients aged 50 to 64 years with a positive mt-sDNA result received a follow-up colonoscopy in both arms, the median time to follow-up colonoscopy was shorter among the population-based outreach (55 vs 136 days; P <.05). Conclusions: Office visit-based interaction was associated with a higher mt-sDNA completion rate as compared to the population-based outreach among average-risk, CRC screening-eligible individuals aged 50 to 64 years old. [ABSTRACT FROM AUTHOR]

Low-income young Black men experience a disproportionate burden of violent injury in the United States. These men face significant disparities in healthcare insurance coverage and access to care. The Affordable Care Act (ACA) created a new healthcare workforce, Navigators and In-Person Assisters (IPAs), to support low-income minority populations with insurance enrollment. Using a longitudinal qualitative case study approach with Navigators and IPAs at the two busiest urban trauma centers in Maryland, this study identifies the culturally and structurally responsive enrollment strategies used by three Navigators/IPAs as they enrolled violently injured young Black men in healthcare insurance coverage. These approaches included gaining their trust and building rapport and engaging female caregivers during enrollment. Navigators and IPAs faced significant barriers, including identity verification, health literacy, privacy and confidentiality, and technological issues. These findings offer novel insight into the vital work performed by Navigators and IPAs, as they attempt to decrease health disparities for young Black male survivors of violence. Despite high rates of victimization due to violent firearm injury, little is known about how this population gains access to healthcare insurance. Although the generalizability of this research may be limited due to the small sample size of participants, the qualitative case study approach offers critical exploratory data suggesting the importance of trauma-informed care in insurance enrollment by Navigators and IPAs. They also emphasize the need to further address structural issues, which affect insurance enrollment and thus undermine the well-being of young Black men who have survived violent injury. [ABSTRACT FROM AUTHOR]

This study will highlight the diagnostic potential that radar plots display for reporting on performance benchmarking from patient admissions to hospital for surgical procedures. Two drawbacks of radar plots – the presence of missing information and ordering of indicators – are addressed. Ten different orthopaedic surgery procedures were considered in this study. Moreover, twelve outcome indicators were provided for each of the 10 surgeries of interest. These indicators were displayed using a radar plot, which we call a scorecard. At the hospital level, we propose a facile process by which to consolidate our 10 scorecards into one. We addressed the ordering of indicators in our scorecards by considering the national median of the indicators as a benchmark. Furthermore, our the consolidated scorecard facilitates concise visualisation and dissemination of complex data. It also enables the classification of providers into potential low and high performers that warrant further investigation. In conclusion, radar plots provide a clear and effective comparative tool for discerning multiple outcome indicators against the benchmarks of patient admission. A case study between two top and bottom performers on a consolidated scorecard (at hospital level) showed that medical provider charges varied more than other outcome indicators. [ABSTRACT FROM AUTHOR]

Although the number of men with health insurance has increased, men are less likely to utilize health services than females, and experience difficulty in paying medical bills. Understanding the details of health insurance can be challenging and the lack of understanding can have financial consequences. This study, guided by Andersen's model of health-care utilization, assessed the relationship between confidence level in understanding health insurance terms and difficulty in paying medical bills among American men. Data were drawn from the Health Reform Monitoring Survey, 2015-2016. The study included 6,643 men aged between 18 and 64. Descriptive statistics examined participants' difficulty in paying medical bills by predisposing, enabling, and need characteristics, and by confidence in understanding health insurance terms. A modified Poisson regression analysis examined the association between difficulty in paying medical bills, confidence in understanding health insurance terms score, and predisposing, enabling, and need characteristics. An increase in confidence in understanding health insurance terms score was associated with significantly lower reported difficulty in paying medical bills (PR = .98; 95% CI = [.97-.99]; p = .002). Participants with a college degree or higher were less likely to report difficulty in paying their medical bills compared to participants with less than a high school degree (PR = .72; 95% CI = [.56-.92]; p = .009). A better understanding of health insurance might prevent men from experiencing difficulties in paying medical bills. Additional research should be performed to understand the relationship between the level of confidence in understanding health insurance, knowledge level of health insurance terms, use of health insurance, and their impact on difficulty in paying medical bills. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to explore variations in cost and choice of travel insurance in patients with cardiac disease. Methods: Clinical data from patients with myocardial infarction (MI, n = 20), Marfan syndrome (MFS, n = 10) and dilated cardiomyopathy (DCM, n = 10) were input to insurance websites for a proposed ten-day holiday and data for premium cost (£) and choice of quotes (n) collated for each condition. Age-matched healthy individuals were used as controls. Results: Median cost of insurance was significantly higher for MI (£233.07; interquartile range (IQR) = £222.95–£245.47 versus £24.29; IQR = £11.9–£34.09, p = <0.001), MFS (£37.43; IQR = £23.61–58.83 versus £19.20; IQR = £9.09–£27.31, p = 0.0378)) and DCM (£166.87; IQR = £129.71–£198.62 versus £23.96; IQR = £11.99–£32.44, p = <0.001) compared to controls. Choice of quotes was also significantly reduced for MI (5; IQR = 5–14 versus 89; IQR = 26–110, p = <0.001) MFS (61; IQR = 26–83 versus 105; 26–105, p = <0.001) and DCM (19; IQR = 16–28 versus 89; IQR = 26–106, p = <0.001) compared to controls. Modifiable factors, such as time after cardiac event or awaiting further investigations, and clinical factors, such as persistent symptoms and disease severity, lead to a significant increase in cost. Conclusions: This study provides insight into the factors affecting cost and choice of travel insurance for patients with cardiac disease. The findings highlight ways in which healthcare professionals can support patients to obtain travel insurance. [ABSTRACT FROM AUTHOR]

Universal Health Coverage always persevered as a pro poor policy in many countries, characterized by a major impact on higher out-of-pocket healthcare costs, with low-cost alternative prescription drugs and capitation payments made to physicians, in order to reduce inequity. These concerns have been discussed widely on social media, including Facebook, but social media are consistently neglected as a source of scientific information. The purpose of this study, therefore, is to analyze the thought process or feelings of individuals about the policies, also focusing on the possible reactions. Hence, a systematic review in the form of discussion forums on the Facebook page of the National Health Insurance Agency, Indonesia was conducted from 2015 to 2016, with regards to the implementation of National Health Insurance, within a year and half after the policy was launched. In addition, the contents of 148 discussions were deductively analyzed, and the findings showed the pragmatic disposition of most Facebook users towards health care utilization, the costs of Insurance, and the possible benefits of payment. Furthermore, the debate conducted in social media related with the policy and its practice issues ought to be countered through appropriate modification. [ABSTRACT FROM AUTHOR]

The primary objective of "all-payer" rate setting—regulatory regimes through which states set hospital payment rates for all insurers—was to control costs through consistent, centrally regulated payments. These regimes were often linked, however, to an ancillary goal of financing care for the uninsured. We show that the surcharge mechanism used to achieve this secondary objective decreased the stability of these payment regimes. This instability reflected a feedback loop from surcharge rates to insurance coverage and back to the quantities of uncompensated care in need of financing. Instability was exacerbated when Health Maintenance Organizations were exempted from surcharge collections, creating a regulatory arbitrage opportunity. Legal challenges connected to the incidence of uncompensated care surcharges contributed to the abandonment of all-payer rate regulation by several states. These developments illustrate the wisdom of the Tinbergen Rule, which recommends that independent policy objectives be met with independent policy instruments. [ABSTRACT FROM AUTHOR]

Objectives: Research suggests that persons who are aware of the risk factors for cardiovascular disease (CVD) are more likely to engage in healthy behaviors than persons who are not aware of the risk factors. We examined whether patients whose insurance claims included an International Classification of Diseases, Ninth Revision (ICD-9) code associated with hypertension who self-reported high blood pressure were more likely to fill antihypertensive medication prescriptions and less likely to have CVD-related emergency department visits and hospitalizations (hereinafter, CVD-related events) and related medical expenditures than patients with these codes who did not self-report high blood pressure. Methods: We used a large convenience sample from the MarketScan Commercial Database linked with the MarketScan Health Risk Assessment (HRA) Database to identify patients aged 18-64 in the United States whose insurance claims included an ICD-9 code associated with hypertension and who completed an HRA from 2008 through 2012 (n = 111 655). We used multivariate logistic regression analysis to examine the association between self-reported high blood pressure and (1) filling prescriptions for antihypertensive medications and (2) CVD-related events. Because most patients with hypertension will not have a CVD-related event, we used a 2-part model to analyze medical expenditures. The first part estimated the likelihood of a CVD-related event, and the second part estimated expenditures. Results: Patients with an ICD-9 code of hypertension who self-reported high blood pressure had a significantly higher predicted probability of filling antihypertensive medication prescriptions (26.5%; 95% confidence interval, 25.7-27.3; P <.001), had a significantly lower predicted probability of a CVD-related event (0.6%, P <.001), and on average spent significantly less on CVD-related events ($251, P =.01) than patients who did not self-report high blood pressure. Conclusion: This study affirms that self-knowledge of high blood pressure, even among patients who are diagnosed and treated for hypertension, can be improved. Interventions that improve patients' awareness of their hypertension may improve antihypertensive medication use and reduce adverse CVD-related events. [ABSTRACT FROM AUTHOR]

To assess whether near-poor parents' job mobility is reduced due to the non-portability of employer-provided health insurance--an effect termed job lock--the authors examine data from the Survey of Income and Program Participation for 1996 and 2001, years bracketing the introduction of the State Children's Health Insurance Program (SCHIP). Among the working fathers whose children met the SCHIP eligibility criteria, those whose wives did not have their own employer-provided insurance were 5-6% more likely to separate from their current employer in the year of the later survey than in the year of the earlier survey, whereas those whose wives were insured exhibited no comparable change in mobility. These results confirm the presence of job lock: for men whose wives were uninsured, but not for those whose wives were insured, the authors argue, the SCHIP program presented a new opportunity to switch jobs without losing health insurance. [ABSTRACT FROM AUTHOR]

This article comments on a research paper "Pathways to Medicine Use." In that article the authors employed path analysis to predict the use of prescribed and nonprescribed drugs by a sample of 2,378 adults from the Baltimore SMSA. Three sets of independent variables were included in the analysis: "predisposing" variables such as age, sex, and race; "enabling" variables, have Medicare, have Medicaid, perceived availability of care, drug expense, economic class, and time to MD; "need for care" variables, perceived morbidity, and anxiety. In their discussion of the findings, for example, they argue that women". . . did report more anxiety, and it is mainly through this intervening variable that they use more prescribed medicines." Yet the indirect effect of sex through anxiety is only about .03, with the remaining .04 of what they label indirect effect consisting of non-causal association. Similarly, they conclude that "nonwhites have somewhat lower rates of medicine use than whites, directly and indirectly. through the link of Medicaid to perceived morbidity . . ., suggesting that there were some cultural differences in regard to use of medicines."

Because the near-elderly have high expected medical expenditures, availability of health insurance is an important factor in their retirement decisions. Using Health and Retirement Study data collected in 1992-2002, the authors of this study investigate whether access to employer-provided retiree health insurance enabled dual working couples to time their retirement together--a behavior called "joint retirement." They find that when wives had employer-provided retiree health insurance, the likelihood of joint retirement more than doubled. The effect of retiree health insurance on overall employment patterns, in contrast, was modest: estimates indicate that a hypothetical change from universal availability of such insurance to its universal unavailability would have increased employment levels by only two percentage points. [ABSTRACT FROM AUTHOR]

During the past two decades, union density has declined in the United States and employer provision of health benefits has changed substantially in extent and form. Using individual survey data spanning the years 1983-97 combined with employer survey data for 1993, the authors update and extend previous analyses of private-sector union effects on employer-provided health benefits. They find that the union effect on health insurance coverage rates has fallen somewhat but remains large, due to an increase over time in the union effect on employee 'take-up' of offered insurance, and that declining unionization explains 20-35% of the decline in employee health coverage. The increasing union take-up effect is linked to union effects on employees' direct costs for health insurance and the availability of retiree coverage. [ABSTRACT FROM AUTHOR]

This study randomized a sample of households covered by one large health plan to two different surveys on health insurance coverage and matched person-level survey reports to enrollment records. The goal was to compare accuracy of coverage type and uninsured estimates produced by the health insurance modules from two major federal surveys – the redesigned Current Population Survey Annual Social and Economic Supplement (CPS) and the American Community Survey (ACS) – after implementation of the Affordable Care Act. The sample was stratified by coverage type, including two types of public coverage (Medicaid and a state-sponsored program) and three types of private coverage (employer-sponsored, non-group, and marketplace plans). Consistent with previous studies, accurate reporting of private coverage is higher than public coverage. Generally, misreporting the wrong type of coverage is more likely than incorrectly reporting no coverage; the CPS module overestimated the uninsured by 1.9 and the ACS module by 3.5 percentage points. Other differences in accuracy metrics between the CPS and ACS are relatively small, suggesting that reporting accuracy should not be a factor in decisions about which source of survey data to use. Results consistently indicate that the Medicaid undercount has been substantially reduced with the redesigned CPS. [ABSTRACT FROM AUTHOR]

Most research on health insurance in the United States uses the Current Population Survey Annual Social and Economic Supplement. However, a recent redesign of the health insurance questions disrupted the historical time trend in 2013. Using data from the American Community Survey, which has a parallel trend in the uninsured rate, we model a bridge estimate of the uninsured rate using the traditional questions. Also, we estimate the effect of changing the questionnaire. We show that the impact of redesigning the survey varies substantially by subgroup. This approach can be used to produce bridge estimates when other questionnaires are redesigned. [ABSTRACT FROM AUTHOR]