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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]

Prescription drug cost-sharing is a barrier to medication adherence, particularly for low-income and minority populations. In this systematic review, we examined the impact of prescription drug cost-sharing and policies to reduce cost-sharing on racial/ethnic and income disparities in medication utilization. We screened 2,145 titles and abstracts and identified 19 peer-reviewed papers that examined the interaction between cost-sharing and racial/ethnic and income disparities in medication adherence or utilization. We found weak but inconsistent evidence that lower cost-sharing is associated with reduced disparities in adherence and utilization, but studies consistently found that significant disparities remained even after adjusting for differences in cost-sharing across individuals. Study designs varied in their ability to measure the causal effect of policy or cost-sharing changes on disparities, and a wide range of policies were examined across studies. Further research is needed to identify the types of policies that are best suited to reduce disparities in medication adherence. [ABSTRACT FROM AUTHOR]

Over 70% of Medicaid beneficiaries are enrolled in Medicaid managed care (MMC). MMC provider networks therefore represent a critical determinant of access to the Medicaid program. Many MMC insurers also participate in commercial insurance markets where prices are high, and some insurers exercise considerable market power. In this paper, we examined the relationship between commercial insurer market power and MMC physician network breadth using linked national enrollment data and provider directory data. Insurers with more commercial market power had broader Medicaid physician networks. Insurers with over 30% market share had 37.3% broader Medicaid networks than insurers in the same county that had no commercial market share. These differences were driven by greater breadth among primary care providers, as well as other specialists including OB/GYNs, surgeons, neurologists, and cardiologists. Commercial insurance market power may have spillovers on access to care for MMC beneficiaries. [ABSTRACT FROM AUTHOR]

In health insurance markets with regulated competition, regulators face the challenge of preventing risk selection. This paper provides a framework for analyzing the scope (i.e., potential actions by insurers and consumers) and incentives for risk selection in such markets. Our approach consists of three steps. First, we describe four types of risk selection: (a) selection by consumers in and out of the market, (b) selection by consumers between high- and low-value plans, (c) selection by insurers via plan design, and (d) selection by insurers via other channels such as marketing, customer service, and supplementary insurance. In a second step, we develop a conceptual framework of how regulation and features of health insurance markets affect the scope and incentives for risk selection along these four dimensions. In a third step, we use this framework to compare nine health insurance markets with regulated competition in Australia, Europe, Israel, and the United States. [ABSTRACT FROM AUTHOR]

This letter to the editor highlights methodological and interpretational issues with a recent paper on private outpatient psychiatric consultation fees in Australia. The authors argue that the study's data collection is incomplete and does not accurately reflect real-world clinical practice. They also point out that the paper fails to acknowledge certain factors, such as state-to-federal cost-shifting and government subsidies, which can affect the estimation of out-of-pocket costs for patients. The authors question the validity of the study's findings and criticize the discussion for proposing actions that are not supported by the data. They suggest that broader consideration of the healthcare context and access to cost subsidies may be necessary to improve equitable accessibility to care. [Extracted from the article]

Purpose: This paper examines community leaders' and researchers' recommendations for reaching rural communities in a southeastern U.S. state with cancer prevention and control programming. Research Design: A qualitative inquiry of a grant network's research and community councils was conducted to explore members' opinions on how to engage rural communities and obtain input on how to recruit rural organizations for a mini-grants program. Study Sample and Data Collection: Telephone/virtual interviews were conducted with all 13 council members. Responses were analyzed using thematic analysis and findings were examined within the context of system-centric and patient-centric dimensions. Results: Council members discussed limited education, lack of insurance, low socioeconomic status, health care avoidance, and transportation as barriers to cancer prevention and control. They recommended reaching rural populations by partnering with community and faith-based organizations, use of targeted multi-media, and tailored cancer education trainings. Conclusions: Findings are used for guiding outreach with rural communities and recruitment of rural organizations for a cancer-focused mini-grants initiative. [ABSTRACT FROM AUTHOR]

The paper investigates the influence of policy ideas from the World Bank and the International Monetary Fund (IMF) on healthcare financing policy in Croatia during the 2002 reform. It contributes to the global social policy literature by providing evidence that the influence of international organisations primarily stems from non-coercive instruments to control the policy agenda, for example, dissemination of ideas, technical assistance and consultations with the recipient government. Even though Croatia was facing economic and political difficulties which weakened its bargaining position vis a vis IOs, the paper shows that impact of coercion and conditionalities attached to international aid was limited. It explains the lenient stance of international organisations by their mission to aid and adjust to a country's needs as well as their self-interest to lend money, to stay in the reform game and to prolong their influence in the future. Consequently, international organisations are willing to bargain and make trade-offs with the recipient government. [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]

Objective: Immigrant health discussions often focus on acculturation and omit discussions on historical events that may underlie health differences among immigrant older adults. This paper provides a historical overview of immigration policy and flows to the U.S. and examines insurance access and health difficulties by sending country. Methods: We analyzed the "Immigrants Admitted to the United States, Fiscal Years 1972–2000" and 2015–2019 American Community Survey datasets to examine the number of admitted immigrants, sociodemographic profiles for current immigrant older adults, and the predicted probabilities of health insurance access and health difficulties. Results: Our results highlight alignment of immigration flows with immigration legislation and vast heterogeneity in migration, health, and healthcare access of immigrants by sending country. Discussion/Implications: Public health practitioners must consider how historical events and social factors contribute to the healthcare access and health of immigrant populations, as demographic shifts will require interventions that promote equitable healthy aging. [ABSTRACT FROM AUTHOR]

England's National Health Service (NHS) is in the process of major reform as old institutional structures based around an internal "market" are being replaced with integrated care systems. The changes represent a significant shift in ethos away from commercialisation to collaboration between health providers. But the way that these policies unfold will depend on the context within which they are implemented, and three decades of neoliberal reforms have left their mark on the structure of the health system. This paper shows how a powerful, politically-connected financialised private sector has evolved alongside a weakened public system, depleted further by the pandemic. While the share of overall public health spending reaching the private sector has not increased greatly over the past decade, private financial investors are strongly embedded in some segments of health delivery, particularly mental health services where shareholder returns are boosted by financial engineering. The boundaries between private and public are increasingly blurred with the NHS treating private patients and self-payment for health services is increasingly normalised. Rather than traditional privatisation, the health system is facing a more subtle and pernicious erosion of public services across different dimensions which seems likely to continue despite the new reforms. [ABSTRACT FROM AUTHOR]

The dependent coverage expansion (DCE), a component of the Affordable Care Act, required private health insurance policies that cover dependents to offer coverage for policyholders' children through age 25. This review summarizes peer-reviewed research on the impact of the DCE on the chain of consequences through which it could affect public health. Specifically, we examine the impact of the DCE on insurance coverage, access to care, utilization of care, and health status. All studies find that the DCE increased insurance coverage, but evidence regarding downstream impacts is inconsistent. There is evidence that the DCE reduced high out-of-pocket expenditures and frequent emergency room visits and increased behavioral health treatment. Evidence regarding the impact of the DCE on health is sparse but suggestive of positive impacts on self-rated health and health behavior. Inferences regarding the public health impact of the DCE await studies with greater methodological diversity and longer follow-up periods. [ABSTRACT FROM AUTHOR]

Objective: Terminating a therapeutic relationship can be particularly challenging and onerous for the treating medical practitioner. There are multiple reasons why a practitioner may desire to terminate the relationship, ranging from inappropriate behaviour and assault through to threatened or actual litigation. This paper provides psychiatrists as well as all doctors and support staff who work alongside them with a simple, step-by-step visual guide to terminating a therapeutic relationship, giving due consideration to their professional and legal obligations in line with common recommendations by medical indemnity organisations. Conclusions: If a practitioner's ability to manage the patient is inadequate or compromised due to an emotional, financial, or legal circumstance, it is reasonable to consider termination of the relationship. Practical steps such as taking contemporaneous notes, writing to the patient and their primary care doctor, ensuring continuity of healthcare, and communicating with authorities where appropriate have been identified as components commonly recommended by medical indemnity insurance organisations. [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]

Most US workers have health insurance plans sponsored and subsidized by their employers. The US Affordable Care Act (ACA) improved and expanded the availability of non-employer-based health insurance, with protections for pre-existing conditions, guaranteed issue, and community rating in non-group markets. Using National Health Interview Survey data for 2009 to 2018 and a difference-in-differences modeling approach, this study finds that the ACA increased self-employment in 2015 and 2016 among US adults with higher demand for health insurance. The probability of self-employment increased by 1.4 to 1.8 percentage points among adults ages 30 to 64 with at least one pre-ACA declinable condition and no alternative source of health insurance through a spouse's employer or public programs. However, these effects were short-lived. As uncertainty about the long-term viability of the ACA's health insurance exchanges increased in 2017 and 2018, the probability of self-employment among individuals with high demand for insurance fell to pre-ACA levels. [ABSTRACT FROM AUTHOR]

This methodological paper systematically describes the steps towards exploring client-perceived barriers to enroll in the National Health Insurance Scheme in Ghana. To respond to the stagnating enrollment rate and to provide evidence-based information for developing policy and practice, the request for this study was made by the insurance authority. We adopted a Participatory Action Approach (PAA) and employed a linked trajectory of qualitative and quantitative methods to inquire deeply into clients’ motives and assumptions, and the root causes of these barriers, while transferring learning among multiple stakeholders in the system: the client, the healthcare provider, and the insurer. Data were collected in 2011 and 2012 among clients in their local communities in two regions in Ghana. Clients were participants in the research, expressing and sharing their emic perspectives and commonly shared opinions with the other stakeholders. This paper explores the contribution of the PAA to healthcare and health insurance studies. We claim that the PAA is a necessary approach for the study of a complex situation such as the health insurance context in Ghana as well as for the facilitation of learning and democratic decision-making. Making multidisciplinary stakeholders, including clients, part of the research contributes to finding solutions that are acceptable to different stakeholders. Our study contributes to PAA methodology knowledge and provides new insights on combining qualitative and quantitative research methods. We propose this as a model to be used within action research that can also be applied in other contexts outside of Africa. [ABSTRACT FROM AUTHOR]

Despite vigorous interest in showing the association between economic determinants and suicide, not many studies have focused on the social protection that can moderate the detrimental impact of the economic environment on suicide. This article is the first to review the relationship between suicide and social protection. In this article, I summarize the empirical findings and theoretical approaches in published papers on the relationship between suicide and social protection, and I identify knowledge gaps for future studies. The review included all quantitative and qualitative articles published in peer-reviewed journals, regardless of study setting, language, and time period. Among 19 papers meeting the inclusion criteria, 16 studies reported at least one negative association, 2 studies failed to prove a statistical association, and 1 study showed ambiguous results. However, due to the heterogeneity of contexts, the diversity of indicators of social protection, and the paucity of theoretical mechanisms for interpreting the results, further research is required in this area. [ABSTRACT FROM AUTHOR]

Applying Andersen's health care utilization model, this paper shows the prevalence of immigrants' medical and dental tourism and associated factors. An analysis of the 2003 New Immigrant Survey data shows that about 17% of immigrants received medical care in a foreign country, whereas about one-third obtained dental care outside the United States. Latino immigrants have a higher prevalence of both types of tourism than their Asian counterparts. Race, level of education, and health insured status are commonly associated with medical and dental tourism. The findings contribute to the scarce literature on immigrants' health care utilization and medical and dental tourism. [ABSTRACT FROM AUTHOR]

Several countries with diverse health systems have achieved universalization (UHC). The trajectory towards universal coverage almost always has three typical features: (i) a political process driven by a range of regulatory changes to simplify access; (ii) an increase in health spending; (iii) an increase in the share of pooled spending rather than paid out-of-pocket. Therefore, a study was undertaken to understand the extent of the provider-purchaser relationship of governments to achieve UHC while reforming healthcare. The present paper focuses on extensive secondary research across countries and evaluates the experiences of select developed and developing economies with India's experiments on- Financing mechanisms, management arrangements, governance and health outcomes; to offer a comparison of practices and their impact. While Italy, the UK, Germany, Australia, Japan, Canada and most recently China are countries that have achieved UHC; countries like USA and Brazil are on the verge of achieving UHC. These nine countries represent the entire spectrum of pure purchasing models, mixed and pure provisioning models to help us leverage from their experience. All countries that have attained UHC have a well-defined package of services that the government commits to fund and provide for (both public and private). Additionalities around wellness and cosmetic care is managed through supplementary insurance. Overall funding is through an autonomous body, at arm's length of government; primarily to govern and manage the state's health priorities. And the government purely behaves as a regulator setting policy and giving directions to the providers. However, ensuring the sustenance of such a mixed model requires; (i) a well-regulated ecosystem that thrives on evidence, (ii) the governments must clearly define the role/s of each stakeholder and hold them accountable for their deliverables in attaining UHC. [ABSTRACT FROM AUTHOR]

The boundaries of what constitutes "sufficient" health have always been open and, as such, health care has proven to be an opportune area for profit growth. In the United States, the allure of health as a market commodity has proven very strong, but even here it cannot be a mere spontaneous product of the market. It requires government to foster and develop public policy that effectively promotes and maintains health care delivery across the population. Historically, U.S. public policy has veered away from anything akin to universal care, and it has typically been understood as an outlier among advanced industrial states. But, simultaneously, it is also the largest health care market in the world, soon to engulf a full fifth of its GDP. In this paper, I argue that the complicated dynamic between a growing market in health delivery and a patchwork of political reforms has encouraged "adaptive accumulation," a process whereby capital secures optimized accumulation outcomes from enhanced government intervention, deriving extra-market benefits along the way. To make this argument, I explore critical components of the health system, including Medicare Advantage, Medicare Part D, as well as the Affordable Care Act and its aftermath. [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]

Patient satisfaction is important in healthcare as it affects the quality of care and can lower costs in hospitals. This study aimed to measure immigrant satisfaction with outpatient services at Firoozabadi Hospital's pediatric clinic. Data were collected from immigrant patients from January to July 2023. The Patient Satisfaction Questionnaire 18 and the personal information checklist were used in oral interviews with caregivers. The overall satisfaction score was 72.95 out of 90, with a standard deviation of 12.57. Financial issues received the lowest satisfaction scores, while interpersonal manner received the highest ratings. Out of the 241 respondents, 48.6% were completely satisfied, 32.7% were satisfied, 10.6% had no opinion, and 4.4% expressed dissatisfaction. Satisfaction levels were not correlated with income, education, possession of identification documents or health insurance, and length of stay in Iran. Overall, most participants were happy with the outpatient services, but many lacked health insurance. Providing easier access to health insurance for immigrants could help reduce dissatisfaction with expensive medical bills. [ABSTRACT FROM AUTHOR]

This study examines the health care utilization pattern, associated financial catastrophes, and inequality across Indian states to understand the subnational variations and aid the policy makers in this regard. Data from recent National Sample Survey (2017–2018), titled, "Household Social Consumption: Health," covering 113,823 households, was employed in the study. Descriptive statistics, Erreygers concentration index (CI), and recentered influence function decomposition were applied in the study. We found that, in India, 7 percent of households experienced catastrophic health expenditure (CHE) and 1.9 percent of households were pushed below poverty line due to out-of-pocket expenditure on hospitalization. Notably, outpatient care was more burdensome (CHE: 12.1%; impoverishment: 4%). Substantial interstate variations were observed, with high financial burden in poorer states. Utilization of health care services from private health care providers was pro-rich (hospitalization CI 0.31; outpatient CI 0.10), while the occurrence of CHE incidence was pro-poor (hospitalization CI −0.10; outpatient CI −0.14). Education level, economic status, health insurance, and area of residence contributed significantly to inequalities in utilization of health care services from private providers and financial burden. The high financial burden of seeking health care necessitates the need to increase public health spending and strengthen public health infrastructure. Also, concerted efforts directed towards increasing awareness about health insurance and introducing comprehensive health insurance products (covering both inpatient and outpatient services) are imperative to augment financial risk protection in India. [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]

This article estimates the effect of labor-market concentration on labor compensation across the US private sector since 2000. The authors distinguish between concentration in local labor markets and local product markets while guarding against bias from confounded product-market concentration. The analysis extends beyond wages to rates of employment-based health insurance coverage. Reported results suggest negative effects of labor-market concentration on labor compensation. These effects are exacerbated when product-market concentration is higher or when workers are older. [ABSTRACT FROM AUTHOR]

Social determinants of health (SDOH) are structural factors that yield health inequities. Within the context of cancer, these inequities include screening rates and survival rates, as well as higher symptom burden during and after treatment. While pain is one of the most frequently reported symptoms, the relationship between SDOHs and cancer pain is not well understood. The purpose of this study is to describe and synthesize the published research that has evaluated the relationships between SDOH and cancer pain. A systematic search of PubMed, CINAHL, and Embase was conducted to identify studies in which cancer pain and SDOH were described. In all, 20 studies met the inclusion criteria. In total, 14 studies reported a primary aim related to SDOH and cancer pain. Demographic variables including education or income were used most frequently. Six specific measurements were utilized to measure SDOH, such as the acculturation scale, the composite measure of zip codes for poverty level and blight prevalence, or the segregation index. Among the five domains of SDOH based on Healthy People 2030, social and community was the most studied, followed by economic stability, and education access and quality. The neighborhood and built environment domain was the least studied. Despite increasing attention to SDOH, the majority of published studies use single-dimension variables derived from demographic data to evaluate the relationships between SDOH and cancer pain. Future research is needed to explore the intersectionality of SDOH domains and their impact on cancer pain. Additionally, intervention studies should be conducted to address existing disparities and to reduce the incidence and impact of cancer pain. [ABSTRACT FROM AUTHOR]

Introduction: Adoption of telemedicine by healthcare facilities has dramatically increased since the start of coronavirus pandemic; yet, major differences exist in universal acceptance of telemedicine across different population groups. The goal of this study was to examine population-based factors associated with current and/or future use of telemedicine in Alabama. Methods: A cross-sectional survey was administered to 532 participants online or by phone, in four urban and eight rural counties in Alabama. Data were collected on: demographics, health insurance coverage, medical history, access to technology, and its use in accessing healthcare services. Generalized logit regression models were used to estimate the odds of choosing "virtual visit" and "phone communication" compared to "in-person visit" for the preferred choice of visit with the healthcare provider; as well as odds for willingness to participate in "virtual visit" in the future. Results: Our study sample had a mean age of 43 (±15) years, 72.9% women, 45.9% Black or African American; 59.4% population living in an urban county. The odds of "phone communication" were higher compared to the odds of "in-person visit", with a unit increase in age (odds ratio: 1.02, 95% confidence interval: 1.00–1.03), after adjusting for other covariates. Among participants with past experience of virtual communications, the odds for choosing "virtual visit" were significantly higher compared to choice of in-person visit (odds ratio for virtual visit: 3.23, 95% confidence interval: 2.01–5.18), adjusted for other covariates. Further, people with college or more education were 71% less likely to choose "No" compared to those with high school or lower general education development education for future virtual visit [odds ratio for college or more: 0.29, 95% confodence interval: 0.10–0.87). Likewise, participants residing in rural counties were 57% less likely to choose "No" compared to urban counties for future virtual visit (odds ratio for rural participants: 0.43, 95% confidence interval:0.19–0.97) Discussion: Our study found notable differences in age, education, and rurality for use and/or preference for telemedicine. Medical institutions and healthcare providers will need to account for these differences to ensure that the implementation of telemedicine does not exacerbate existing health disparities. [ABSTRACT FROM AUTHOR]

School nurses are important participants in School Medicaid (SM) programs nationally. Yet, the complexity of SM programs and required documentation are major barriers to implementing this program for nurses. School nurses are often required to participate in the SM program without having a clear understanding of the purpose and components of the overall program. With the expansion of SM programs due to the Centers for Medicare and Medicaid Services "free care" guidance change, nursing services and documentation are receiving more attention and scrutiny as more nursing services become eligible for reimbursement in states across the country. This article presents a clear overview of SM, its history, different components of state SM programs, school nursing documentation and challenges, and resources for school nurses who are interested in more information. [ABSTRACT FROM AUTHOR]

The objective of universal health care systems is to achieve equality in the use of health services at the same level of care need. This study evaluates the relationship of socioeconomic position with the frequency of doctor visits in subjects with and without chronic diseases in Germany and Spain. The dependent variables included number of consultations and if a medical consultation occurred. The socioeconomic factors were income and education. The magnitude of the relationship between socioeconomic position and medical consultation frequency was estimated by calculating the percentage ratio using binomial regression and by calculating the difference in consultations by analysis of the covariance, in the case of number of visits. Statistically significant findings according to education were not observed. The percentage ratio in the medical consultations among those with lower and higher income was 1.03 (95% confidence interval [CI] 1.01-2.88) in Germany and 1.11 (95% CI 1.03-1.20) in Spain among subjects with any of the studied chronic conditions. Also, in Germany the difference in the average number of consultations comparing lower income subjects with higher was 3.98 (95% CI 2.40-5.57) in those with chronic conditions. In both countries, there were no differences in the frequency of doctor visits according to education. However, a pro-inequality trend exists in favor of subjects with lower income. [ABSTRACT FROM AUTHOR]

This study examined how interruptions in insurance coverage affect purchases of prescription drugs for young adults. It used data spanning 2014 to 2018 from Kentucky's prescription drug monitoring program, which tracked the universe of federally-regulated (Schedule II–V) prescription drugs dispensed in the state. The study employed a regression discontinuity design based on the age limit at 26 for dependent insurance coverage for children. At age 26, the probability of purchasing a prescription decreased by 5%, with all subcategories of prescriptions affected. The share of generic prescriptions increased for stimulants (the only category observed with substantial branded prescriptions). By age 27, prescription purchases returned to levels observed at 25, but the share purchased with public insurance and the generic share for stimulants remained higher. The findings suggest that interruptions in insurance coverage decrease prescription drug utilization by young adults and that public insurance programs such as Medicaid are important for resuming treatment. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this paper are to analyse the determinants of prostate cancer screening uptake in the Republic of Ireland and to compare the role of non-need factors in uptake of screening among those in and outside the age range recommended as cost-effective for screening according to the European Randomised Study of Screening for Prostate Cancer (ERSPC). Methods: The investigation combined a logistic regression analysis of uptake, with an estimation of incomerelated concentration indices and decomposition of the indices using data collected as part of the Survey of Lifestyle and Nutrition (SLAN) 2007. Comparisons were made across groups differentiated by age in terms of the expected value of the prostate cancer screening. Results: Uptake of prostate screening in men 40 years and over in the preceding 12 months was approximately 24%. Uptake was higher among those in age groups that are perceived to receive most benefit from a Prostate Specific Antigen (PSA) test based on the findings of the ERSPC trial. Screening is highest in those with highest socioeconomic status and educational attainment, and who also hold private insurance cover. The largest socioeconomic inequality is observed for men over 70 years of age (0.2298). The smallest inequality was observed for those aged 55-69 (0.1573). Decomposition of the concentration indices shows that possession of private insurance is the largest determinant of inequality among those aged 55-69 (36%) and remains a significant determinant for those aged 40-54 (26%) and those aged 70 and over (17%). Conclusions: There are high levels of prostate cancer screening uptake and significant income-related inequality in uptake in the Republic of Ireland. Given that the merits of prostate cancer screening overall and across different age groups are the subject of debate, the high levels of screening and income-related inequalities in uptake warrant closer attention and identification of potential policy responses. [ABSTRACT FROM AUTHOR]

The provision of healthcare is a major global preoccupation and there is a continuing challenge due to a growing demand with finite resources. The tensions at play mean that people and their quality of life, which ought to be the main value considered, can be given lower priority than aspects of health economics and informatics. In this paper the authors demystify the economics and informatics of healthcare, and challenge policy makers and project managers to put nursing care in the fore in their decision-making. As an illustration of the non-negotiable patient-centric values Parse’s contributions to nursing are suggested. [ABSTRACT FROM PUBLISHER]

In 2003, a large German public health insurance fund launched the GesundheitsCard Europa (GCE) or Health Card Europe. Staff in the 14 participating hospitals along the Dutch and Belgium coast could use a multilingual Website to confirm immediately the insurance status of patients presenting a GCE. Reimbursement was speeded up by using the Web portal in co-operation with the insurance partners. A thorough analysis of the economic performance of the GCE service, accounting for all stakeholders was conducted. The number of paper forms issued by the insurer for travel to The Netherlands fell from about 200,000 annually to about 40,000 per year. In 2004, three years after the project started, cumulative benefits exceeded cumulative costs. The investment was about €500,000 and the annual running costs were about €150,000. In comparison, the overall annual net benefits were about €450,000. The GCE is a proprietary, but generalisable solution to a specific European problem: low acceptance of health insurance certificates. [ABSTRACT FROM AUTHOR]

On 8th December, 2003, President Bush signed into law the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Title XI of the Act, referred to herein as the Access to Affordable Pharmaceuticals Act (AAP), represents the most significant revision to pharmaceutical law since 1984, when the Hatch-Waxman Act was first passed into law. The purpose of this paper is to summarise the aspects of AAP that are most important for the generics industry. [ABSTRACT FROM AUTHOR]

Objectives: Interest in the composition of the health care menu has grown. Its outwardly comprehensive nature is as rhetorical as the slogans of universal access and affordability. This paper summarizes the international part of a report to the Swiss government, in which we explored the basic package of services covered by social health insurance in France, Germany, Israel, Luxembourg, The Netherlands and Switzerland. The aim of the initial report was to check the appropriateness of the Swiss catalogue, with special attention to the risk of unequal access to health care by rationing of effective services. In this paper, we highlight the major differences in service coverage between the countries and address the possible factors explaining those differences. Methods: The contents of the basic packages of the six countries were compared using data from government ministries and sickness funds. Results: Coverage is most comprehensive in Germany and Switzerland; these are also the countries with the greatest total health expenditure. Three countries separated nursing care from other types of health care by creating an independent insurance scheme. Some health care benefits are also covered under the heading of social care. High out-of-pocket payments are increasingly used as hidden rationing instruments. Conclusions: The present comparison highlights the multi-factorial character of the choices made in six countries in order to keep their health care menu within the possibilities offered by available resources. [ABSTRACT FROM AUTHOR]

Occupational health and safety research rarely makes use of data on employee healthcare utilization to gain insight into the physical and mental health of healthcare staff. This paper aims to fill this gap by examining the prevalence of two relevant types of healthcare utilization among staff working in healthcare organizations: physical therapy and mental healthcare utilization. The paper furthermore explores what role employee and organizational characteristics play in explaining differences in healthcare utilization between organizations. A Dutch healthcare insurance company provided healthcare utilization records for a sample of 417 organizations employing 136,804 healthcare workers in the Netherlands. The results showed that there are large differences between and within healthcare industries when it comes to employee healthcare utilization. Multivariate regression analyses revealed that employee characteristics such as age and gender distributions, and healthcare industry, explain some of the variance between healthcare organizations. Nevertheless, the results of the analyses showed that for all healthcare utilization indicators there is still a large amount of unexplained variance. Further research into the subject of organizational differences in employee healthcare utilization is needed, as finding possibilities to influence employee health and subsequent healthcare utilization is beneficial to employees, employers and society as a whole. [ABSTRACT FROM AUTHOR]

This overview article provides a conceptual introduction to this special issue on health care choices, containing four main papers originally commissioned in 1997 for a conference titled "The Power of Choice in the Health Care Marketplace and Its Consequences," sponsored by The Robert Blood Johnson Foundation under its Changes in Health Care Financing and Organization (HCFO) program and conducted by the Alpha Center on November 19,1997. Drawing on information from these four papers, the authors discuss what factors affect the different choices we face, highlighting the fact that different players in the health care system face diverse and often conflicting choices and trade-offs. The authors then examine the consumer choice model and its premise that when consumers are presented with adequate information about these different choices, they will make selections about plans, providers, and health insurance that will move the health care system toward a higher quality/lower cost equilibrium. [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]

Korean Americans in the United States are more likely than other Asian ethnic groups to lack health insurance despite their high education and economic prosperity. According to the model of health service selection, immigrants' perceptions of the health care system and health care behaviors in their host country are affected by sociocultural referents including premigration health care experience in the country of origin. This study explored Korean immigrants' perceptions of health insurance and their intentions to purchase and maintain health insurance in the United States. We conducted in-depth interviews with 24 self-employed Korean immigrants who migrated from South Korea and were living in the Greater Los Angeles area in 2015. Participants generally had negative perceptions of U.S. health insurance in terms of cost, benefits, simplicity, and accessibility. Coupled with their positive experiences with the single-payer, universal health insurance in South Korea, respondents evaluated U.S. health insurance as not worth purchasing, and indicated they would not maintain health insurance once the individual mandate of the Affordable Care Act was abolished. On the contrary, respondents who immigrated prior to the establishment of the Korean universal health insurance in South Korea were relatively satisfied with U.S. health insurance and had maintained health insurance for substantial periods of time. Korean immigrants' premigration health care experiences appeared to influence their decisions to purchase health insurance in the United States and their intention to maintain health insurance. The study findings highlight the necessity of tailored health education that takes into account sociocultural determinants of health coverage among immigrants. [ABSTRACT FROM AUTHOR]

People receiving government assistance have personal stakes in the political process and intimate knowledge of policy implementation. However, data limitations have made it hard to measure voting among those receiving assistance across various programs. Using linked administrative data from a large county in Pennsylvania, merged with the Pennsylvania voter file, we calculate voting rates among benefits recipients. We find that people receiving means-tested benefits (cash assistance, food assistance, health insurance, disability benefits, childcare, and housing) vote at just over half the rate of other county residents (45% compared with 84% in 2020). In the 2020 election, public benefits recipients comprised over 20% of the voting-eligible population but only 12% of voters. To the extent that benefits recipients are more supportive of generous welfare policy than nonrecipients and more familiar with administrative burdens programs impose, this underrepresentation may obscure popular preferences for social welfare provision and shape politicians' attentiveness to program design. [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]

This paper proposes a theoretical framework and an empirical example of the relationship between the civic stratification of immigrants in the United States, and their access to healthcare. We use the 2007 Pew Hispanic Center/Robert Wood Johnson Foundation Hispanic Healthcare Survey, a nationally representative survey of U.S. Latinos (N = 2,783 foreign-born respondents) and find that immigrants who are not citizens or legal permanent residents are significantly more likely to be excluded from care in both the United States and across borders. Legal-status differences in cross-border care utilization persisted after controlling for health status, insurance coverage, and other potential demographic and socioeconomic predictors of care. Exclusion from care on both sides of the border was associated with reduced rates of receiving timely preventive services. Civic stratification, and political determinants broadly speaking, should be considered alongside social determinants of population health and health care. [ABSTRACT FROM AUTHOR]

This article examines the effect of the Affordable Care Act (ACA) dependent coverage mandate on health insurance and labor supply. The author applies three research designs—difference-in-differences, regression discontinuity, and regression kink designs—and conducts extensive robustness checks and falsification tests, along with a formal test for the location of discontinuity and kink. The author finds no discernible evidence of the labor supply impact of the ACA dependent coverage mandate during the first three years after its implementation (2011–2013), despite its substantial impact on health insurance coverage for the eligible young adults. The author attributes this finding to the fact that until 2014, grandfathered plans were not required to provide dependent coverage to those young adult workers who obtained insurance through their own employer. [ABSTRACT FROM AUTHOR]