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As a country, the United States spends significantly more on healthcare than other advanced industrialized countries, and Americans have comparably worse health outcomes. Both are developments of the last four decades. In this paper, we look at how change in antitrust and patent law and thus change in market power in the largest four subsectors of healthcare, hospitals, physician groups, prescription drugs, and net medical insurance, have contributed to the increasing cost of medical care in the United States. We show that the annual rent – the degree to which health care is overpriced as a result of market power – was between 2.47 and 4.30 percent of GDP in 2016 – truly a big cost for big medicine. [ABSTRACT FROM AUTHOR]

The article presents several news related to various universities in the U.S. Indiana University of Pennsylvania has acquired the United Mine Workers of America District 2 Collection. The collection consists of almost 400 boxes and includes papers associated with the presidencies of John Brophy and James Mark and executive files including presidential correspondence, injunctions and other documents. The Knight Library at the University of Oregon has opened the Records of the International Woodworkers of America to researchers. The records, which span from 1936 to 1987 and till nearly 600 linear feet, consist primarily of correspondence, minutes, proceedings, negotiation files, expired contracts, legal and financial documents and officer and departmental records. In addition to the union's basic activities, such as organizing, negotiations, litigation, and strikes, the collection documents the conflict between the red bloc and white bloc forces in the union during the 1940s and 1950s. Papers from the presidency of Keith Johnson deal with Canadian softwood lumber imports, national health insurance, labor law reform, affirmative action, occupational safety and health and other issues.

Many recent papers have documented that there has been a steady decline in the fraction of workers in the US who receive health insurance through their employer. This paper presents an economic model of the labour market that is consistent with observed trends. The primary finding is that the trend is explained by a change in optimal compensation structures for workers due to the increase in the relative price of health care. The paper concludes with an application to the analysis of the increased prevalence of capitated contracts among employers. [ABSTRACT FROM AUTHOR]

With the implementation of the Affordable Care Act (ACA), many homeless persons who previously lacked health insurance gained medical coverage. This paper describes the experiences of homeless persons in accessing and using primary care services, post-implementation of the ACA. Twenty-six semi-structured interviews were completed with homeless persons and primary care providers/staff. Via thematic analysis, themes were identified, categorized by: factors which influence primary care access and use patterns, and strategies to promote consistent primary care use. Maintaining insurance and leveraging systems-based strategies to support primary care access and use may address health disparities and promote health equity. [ABSTRACT FROM AUTHOR]

This paper investigates the influence of goal awareness and IT self-efficacy on job satisfaction based on the motivation sequence model, goal-setting theory, and social cognitive theory. Using a large-scale field survey of healthcare enterprise resource planning (ERP) system users (n = 352), this study investigates these relationships and provides important insight to healthcare ERP system researchers and managers. Both goal awareness and IT self-efficacy influence positive job satisfaction of healthcare ERP system users, as expected. Furthermore, the influence of goal awareness is stronger when the role of ERP systems is highly perceived for decision-making of the job. There was no interaction effect between goal awareness and IT self-efficacy in thepost hocanalysis. The model is significantly supported by the empirical test with the large number of field data from healthcare ERP system users in the healthcare company. Practical and academic implications are discussed in the paper. [ABSTRACT FROM AUTHOR]

Concern is growing in the United States regarding the potential for health insurance benefit designs to discriminate against persons living with HIV as research demonstrates that such practices are occurring. A recent complaint filed against health insurers in seven states alleges that some health insurance companies have been using benefit designs that discourage enrollment of people living with HIV either by not covering essential HIV medications or by requiring cost-sharing for these prohibitively expensive medications. Legislators across the country have reacted by introducing legislation to address these growing problems. This paper describes Assembly Bill 339, legislation passed in California in 2015 and going into effect on 1 January 2017, which provides protection for people living with HIV by requiring coverage for single-tablet regimens to manage HIV while placing a cap on patient cost-sharing. Given California’s size and influence, and the uncertainty of the future of the Affordable Care Act, this legislation has the potential to influence the national policy debate. [ABSTRACT FROM PUBLISHER]

This paper considers the affect of health insurance on children in the United States. Four topics are addressed. First, estimates of the number of children with no insurance or discontinuous coverage are presented. Second, consequences of being uninsured or having gaps in health insurance are considered. Third, a summary of barriers to increasing the extent and continuity of children's health insurance is outlined. Fourth, implications for policy and research are briefl y discussed. It has been well established that heath care in the United States is not the main determinant of health status of the population (McGinnis and Foege, 1993). As a nation, we spend by far more than any other country, yet our population has worse health status as measured by numerous indicators among the 30 developed countries comprising the Organization for Economic Cooperation and Development (Schroeder, 2007). This is due, in part, to determinants of health status that are not addressed by the health care system such as genetic predispositions and, more importantly, lifestyle choices (e.g., diet, physical activity, tobacco, alcohol and drug use, sexual practices, among others), and environmental and social factors (e.g., poverty, employment, housing, socially disintegrated communities, etc.). The ways in which the U.S. health care system is structured and the kinds of health care services that are emphasized (e.g., tertiary care versus primary and secondary prevention), further limit the extent to which health care contributes to health promotion and disease prevention. Nevertheless, availability and accessibility to consistent and high quality health care does influence the health status of the U.S. population, particularly for those at increased risk of various health problems and those with special health care needs (Hoffman and Paradise, 2008) , both of which disproportionately affect poor and minority youth. Indeed, universal health insurance coverage for theelderly may explain, at least in part, why one measure of health status for which the U.S. ranks higher thanmany nations in the Organization for Economic Cooperation and Development is life expectancy among those over 65 years of age (Schroeder, 2007). This paper considers the affect of health insurance on children in the United States. Four topics are addressed. First, estimates of the number of children with no insurance or discontinuous coverage are presented. Second, consequences of being uninsured or having gaps in health insurance are considered. Third, a summary of barriers to increasing the extent and continuity of children's health insurance is outlined. Fourth, implications for policy and research are briefl y discussed. [ABSTRACT FROM AUTHOR]

This paper explores historical and recent trends in the delivery of residential adolescent substance abuse treatment, looking specifically at the impact of managed care on the service delivery system. Three historical eras are conceptualized by the authors: (1) an era prior to managed care in which services were provided on a fee for service basis by health insurance companies and lengths of stay were relatively longer; (2) an era of managed care in which services were funded through managed care organizations and lengths of stay were significantly reduced; and (3) the current era in which residential services are provided through self-pay and through other service systems. Awareness of these changes is important for all practitioners who provide services to adolescents and demonstrate the need to advocates for residential substance abuse services for all adolescents. [ABSTRACT FROM AUTHOR]

Drug abuse and addiction continues to negatively impact many lives in this country. The United States health care system has grappled with how to best serve this vulnerable population. Since the personal and societal costs of addiction are high, all recent iterations of the United States strategic health plans (such as Healthy People 2010) have prioritized this area for improvement. At the local level, health care providers who care for those with addictions are challenged with shrinking insurance coverage for services, a difficult patient population, lack of treatment options, growing ranks of indigent patients, as well as a plethora of additional management challenges. It is known that successful treatment is integrally linked with patient satisfaction with services. The most critical factors in successful addiction treatment (from a patient's perspective) are (1) their belief that the counselor cares about them and, (2) their belief that they can recover. This paper reports a case study in the use of a patient satisfaction survey as a quality management/service refinement tool within a methadone treatment setting. Results indicate that the use of the survey itself provides patients with a tangible cue supporting the presence of the critical success factors. Further, the use of a survey provides a baseline for future measurements and trending. The paper concludes with a discussion of the marketing and organizational implications of incorporating the patient satisfaction survey into the ongoing delivery program for addiction services. [ABSTRACT FROM AUTHOR]

As health care costs have been rising, especially for prescription drugs, employers have curtailed access to employer-sponsored retiree health insurance, especially for future retirees. This paper studies the question whether declining access has already translated into measurable loss of coverage for retirees. Based on data from the Current Population Survey and the Medical Expenditures Panel Survey, we find that retirees have lost health insurance and prescription drug coverage since 1996. The declines are especially pronounced for men before age 65 and for all Medicare-eligible retirees between the ages of 65 and 74. Our results also suggest that coverage will decline in the future. [ABSTRACT FROM PUBLISHER]

This paper presents a qualitative analysis of states' small group health insurance reforms that impact small group premiums, mostly enacted by the states during 1996-99, following the federal Health Insurance Portability and Accountability Act in 1996. It draws from an intensive review of statutes of 48 states and the District of Columbia as of 1999. It analyses regulations related to insurer pricing and rating practices concerning rating criteria and rating bands, pricing incentives, premium stability from year to year, minimum loss rations, re- insurance and carve-out coverage for the medically uninsurable. It also covers regulations targeting employer purchasing and coverage practices such as pooled purchasing and adverse selection. This is the second of a two-part series analyzing states' small group market reforms, the first being devoted to state reforms to promote access and improving the value of health plans offered in this market (Xirasagar et al. 2004). The variety in pricing and rating reforms illustrate the differences in the depth of reforms across states, and represent a far wider range of potential acth- anal combinations than the sample of reforms documented in past literature. [ABSTRACT FROM AUTHOR]

The success of the Affordable Care Act (ACA) and its policy goal of increasing health insurance coverage across the United States, particularly for low income populations, rests in part on community-based outreach activities focused on consumer education and strategies to encourage sign–up. This paper draws on focus group data collected to evaluate and learn from one such community effort, located in a two-state region with significant political opposition to the ACA. Specifically, the research objectives were to better understand low income consumers’ experiences with ACA marketplaces during the initial sign–up period, both barriers and facilitators, and to learn what improvements they recommend for future outreach efforts. Focus group results show very limited knowledge of basic insurance concepts as well as the ACA. Participants reported numerous technological and related access barriers, which further complicated sign–up and caused them to lose confidence and become suspicious of the process. When asked how best to provide information and assistance to individuals such as themselves, participants pointed to several reasons conventional outreach might not be effective and suggested alternative strategies. Although public attention has focused on technical aspects of ACA sign–up, our findings suggest that future obstacles for those who remain uninsured are also likely to be related to perceptions and culturally–based understandings of “Obamacare” and how insurance works. This study underscores the importance of incorporating trusted, community relationships into efforts to expand coverage. [ABSTRACT FROM PUBLISHER]

This study summarizes historical changes among clients entering drug treatment in their sociodemographic characteristics and important pretreament behaviors, such as work activity, criminal behavior, drug use, prior drug treatment, and health insurance. Data are drawn from three major studies of drug abuse treatment clients: the Drug Abuse Reporting Program (DARP), 19694972 the Treatment Outcome Prospective Study (TOPS), 1979-1981; and the Drug Abuse Treatment Outcome Study (DATOS), 1991-1993. The mix of drug treatment clients and their interaction with the drug treatment system changed substantially over the past three decades. Because data items are most directly comparable between TOPS and DATOS, the focus of this paper is on changes within the past decade. The most conspicuous change is in types and numbers of drugs used by clients entering treatment. Multiple drug use declined since the late 1970s, while reports of cocaine use since TOPS more than doubled among clients in the long-term residential and outpatient treatment modalities, and increased 1½ times among methadone clients. Other differences in treatment populations include decreases in clients' working full-time and in reports of suicidal ideation and attempts and predatory crime. Data from such studies as DARP, TOPS, and DATOS are valuable in historical, contextual, policy, and evaluative frameworks. The changing nature of the drug treatment client population-from sociodemographics to drug use and multiple treatment problem seventies-highlights the complexity of issues and difficulties encountered by those attempting to treat clients or plan treatment strategies. [ABSTRACT FROM AUTHOR]

On the basis of a study of forty health care delivery institutions in Florida, California, and New Jersey, this paper examines the interaction between the immigration and health systems in the USA. We investigate barriers to care encountered by the foreign born, especially unauthorized immigrants, and the systemic contradictions between demand for their labour and the absence of an effective immigration policy. Lack of access and high costs have forced the uninsured poor into a series of coping strategies, which we describe in relation to commercial medicine. We highlight regional differences and the importance of local politics and history in shaping health care alternatives for the foreign born. [ABSTRACT FROM AUTHOR]

The recent influx of immigrants aged 65 and older in the United States triggers an increasing need to understand older immigrants' dental services use. This paper uses data (n = 9,617) from the 2004 and 2006 waves of the Health and Retirement Study to examine the dental services use of older Americans. In particular, this study focuses on differences in dental services use between immigrants and natives and potential contributing factors. Multivariate logistic regression analyses showed, contrary to expectation, that older immigrants were more likely to use dental services than older natives despite numerous barriers (odds ratio = 1.30 in 2004). The results in 2006 confirmed these findings. The results from 2004 and 2006 analyses showed dental insurance coverage, sex, and marital status were associated differently with dental services use for immigrants and natives. Implications for current oral health policies and future research of older Americans are discussed, as well as methods for meeting older immigrants' growing dental services needs. [ABSTRACT FROM AUTHOR]

This paper examines the extent to which US citizenship status affects the probability of a person's having a usual source of care and the predictors associated with access to health care among non-citizens. The research is founded on the analysis of data from the 2005 California Health Interview Survey (CHIS) (n = 33,187 adults, ages 18–64). Guided by a modified Andersen model of access to health care, the researchers conducted a series of logistic regression analyses using the survey data to compare native-born citizens with non-citizens who were 1.6 times less likely to access a usual source of care. Among non-citizens, insurance status, shorter duration of residence in the United States, and lower levels of English proficiency were related to a lower probability of having a usual source of care. Based on this research it is argued that affordable health care and health insurance options and access to culturally and linguistically sensitive services are needed to increase access to health care among these identified subgroups of non-citizens. [ABSTRACT FROM AUTHOR]

This paper describes initiatives to privatize the Medicare program over the last 10 years and the implications of these initiatives for the future of retirement security. Our analysis focuses on the privatization provisions of the Medicare Modernization Act, which is largely designed to benefit the corporate health care sector without containing costs or significantly reducing the threat of rising health care costs to the economic security of current and future retirees. In fact, as designed, the Medicare Modernization Act is likely to increase the threat to retirement security in the years ahead. We conclude with a series of policy alternatives to the neoliberal agenda for the privatization of Medicare. [ABSTRACT FROM AUTHOR]

Introduction: This paper describes correlates of use and expenditures for therapies (physical, occupational, speech or home health services) among children in the US. Methods: It examined data from the Medical Expenditure Panel Survey, a nationally-representative US sample. The characteristics of users and described patterns of expenditures were examined. Results: Use is quite low, only 3.8% of children use services or 4.3% once the use that occurs in the special education system is included. Children more likely to use therapy include those with presumably greater need: children with chronic conditions, functional limitations and/or a history of hospitalizations or injuries. There is a significant interaction of minority status and having a functional limitation. Expenditures are low when examined across the child population. Among a small proportion of high users, therapy expenditures account for a large proportion of overall health expenditures. Conclusions: The educational system adds only slightly to the overall rate of use. In general use appears to be related to the need for such services. Some children, likely including racial/ethnic minority children, may under-use services. Lack of insurance is not related to less use, perhaps because there are other ways to get some services (family care or services provided through the public health system) or because not all insurers cover therapy services. Therapy expenditures account for a high proportion of overall expenditures among the high users of therapy whereas, for the entire child population, therapy expenditures account for a very small part of overall health expenditures. [ABSTRACT FROM AUTHOR]

The prescribing of pharmaceuticals by health care providers is influenced by many factors. The significance of these factors is an important consideration to public health advocates and government agencies, health insurance companies, pharmaceutical firms, physician and provider associations, medical ethics researchers, patient consumers, and other stakeholders in health care. Better understanding the factors that motivate physician prescribing can bring about more efficient use of health care resources through the improved dissemination of information and more informed decision making. This paper attempts to provide a sound and inclusive review of the influences upon physician prescribing patterns in the extant literature. This review identifies several factors as being highly influential upon physician prescribing: peer influence, financial and managed care considerations, pharmaceutical representatives and drug samples, and direct-to-consumer advertising. To date, several key areas have not been well researched; these include the perceived price of a drug, the role of new technology, and the impact of physician experience. Based upon the literature review, a theoretical model of individual physician prescribing in the outpatient setting is proposed. Further research might be directed toward determining the influence of each factor upon physician prescribing and testing the overall model and interactions among its individual components. [ABSTRACT FROM PUBLISHER]

Medicaid is a US government insurance programme designed primarily for poor individuals, with expenditures that rose more than 13% in 2002. Thirty-five states have programmes allowing individuals to incur medical expenses at a rate that would make them poor enough to meet Medicaid eligibility criteria. This paper examines the cost of providing care to those spending-down to Medicaid compared to those eligible without spending-down. This longitudinal cohort study compiled inpatient, outpatient and Medicaid data from three academic Infectious Diseases clinics serving approximately 40% of the reported HIV-positive population in North Carolina. Participants included all HIV-positive patients who received care in one of three clinics and received Medicaid coverage at any time from 1996 to 2000 (1,495 individuals). Overall, those who needed to spend-down to Medicaid incurred higher medical costs, following a distinctive pattern of high costs when initially qualified and when ending coverage, and low costs while on spend-down. US states may wish to consider expanding Medicaid's categorically eligible criteria or significantly reducing the frequency with which persons must spend-down to become eligible for Medicaid. [ABSTRACT FROM AUTHOR]

One of the worst forms of inequality in the health care field is the inequality suffered by children. In 1996, over 14.5 million children lived in poverty in the United States. Children who live in poverty are less likely to have health insurance and have less access to health care and thus are more likely to suffer negative outcomes in health care. The Congress of the United States in 1997 enacted the State Children's Health Insurance Program (S-CHIP) to expand health insurance coverage for children. This paper examines the major features of the program, actions undertaken by the state governments under this program to expand health insurance coverage for children, and provides some preliminary analysis of the potential positive and negative impact of the program. [ABSTRACT FROM AUTHOR]

This paper examines the feasibility of achieving U.S. health care reform and prognosis for success. In order to accomplish the task, this paper provides a check list of major problems which emerge continually in the field. In compiling a list of major problems, a tentative list of eight are presented. These problems include the following: unnecessary administrative costs; other major industrial countries can provide adequate health care at a lower rate of the national budget than does the U.S.; increase in malpractice insurance; shortage of primary care physicians in the rural and inner city areas; failure of health insurance; abundance of technology; distribution of care; and increase in health care costs. According to the author, these eight major problems give some indication to the complexity of the issues involved in the health care reform. These problems should be viewed in the context of the five major participant groups in health care: consumers, politicians, physicians and other health care providers, employers, and insurance companies. This paper briefly discusses the affected participants. It also provides a brief review of the proposed solutions to the problem of health care reform.

This paper gives estimates by industry of cost and price impacts of mandatory workplace health insurance, which is part of the National Health Plan (NHP), a legislative proposal of the previous administration. The NHP proposal insures that most US residents have, at minimum, protection against catastrophic medical expenses. The paper briefly (a) describes major aspects of the workplace proposal; (b) discusses its economic effects, including alternative shifting and incidence situations; (c) presents the methodology of the estimates; and (d) summarizes simulation results. [ABSTRACT FROM AUTHOR]

This paper examines the impact that the lack of health insurance has on children and their families. A random sample of families of children who were newly enrolled in a children's health insurance program were interviewed by telephone and asked about the children's health status, the amount of unmet need and delayed care for a number of services, consequences of unmet need and delayed care, usual activities, and the effect on the lack of health insurance. Data were analyzed by using both quantitative and qualitative methods. We found that uninsured children had experienced considerable unmet need and delayed care that increased as the time without insurance increased. The parents reported some adverse consequences. The children were also found to be limited in the extent to which they could participate in various activities specifically because they lacked health insurance. Finally, the parents reported considerable stress and worry associated with their children's lack of coverage. We conclude that being without health insurance has broad consequences for America's children. [ABSTRACT FROM AUTHOR]

The aged are the heaviest users of physician services. An aging population and escalation in medical costs have pressured Medicare budgets, which have increased fastest in Part B physician reimbursement Policy responses include adoption of the Resource Based Relative Value Scale (RBRVS) for physician payment. This paper considers receipt of Medicare revenues by large medical groups and expectations of how groups will fare under RBRVS. In a 73-percent sample of U.S. large group practices, Medicare coverage accounted for one-fourth of clients, Medicare-related revenues for slightly more than one-fourth of revenues, suggesting a slightly higher revenue intensity for Medicare clients, hut showing no evidence of truly disproportionate revenues from Medicare users. Medicare shares of revenues are explained by factors related to Medicare clientele and geriatric service provision. Overly-strict Medicare assignment policy may control costs by limiting access to needed care, rather than by limiting overpayments to physicians. Expectations as to how groups will fare under RBRVS are not found to be related to reliance on Medicare, rather to group auspices and ability to contain costs under Medicare payment. The findings are important not only to physician payment under RBRVS but also under health care reform. [ABSTRACT FROM AUTHOR]

The United States' Affordable Care Act (ACA) of 2010 improved and expanded availability of non-group health insurance. Previous studies have shown that women in the US workforce value health insurance more highly than men do. Because prior to the ACA self-employed individuals did not have guaranteed access to affordable health insurance coverage, women's relatively lower rate of self-employment may partly have reflected their greater "job lock" due to employer-based health insurance. This article employs nationally representative survey data for 2009–18 and a quasi-experimental difference-in-difference modeling approach and finds that unmarried women's probability of self-employment increased by 1.2 percentage points in 2015–18, after the ACA's expansion of non-group health insurance came into effect. Among women who have never married, overall probability of self-employment increased by 1.2–1.5 percentage points versus trend, and the probability of transitioning into full-time self-employment increased by 0.9 percentage points. HIGHLIGHTS In the US, unmarried women are less likely than men to be self-employed. The Affordable Care Act improved access to non-employer-based health insurance, reducing the cost of leaving jobs. As a result, from 2015–2018, unmarried women were increasingly drawn to self-employment. The ACA's expansion of health insurance thus provides important economic benefits beyond healthcare access. [ABSTRACT FROM AUTHOR]

Recent findings suggest that the rate of certain cancers can be reduced by increasing human papillomavirus (HPV) vaccination coverage, resulting in considerable research interest on the antecedents of HPV vaccine receipt to identify avenues to promote vaccination. The current article continues this stream of research by (1) studying the three HPV vaccination outcomes of willingness, receipt, and word-of-mouth, (2) investigating the antecedent effects of sociodemographic characteristics, health insurance status, provider conversation, and political orientation, and (3) testing the mediating role of vaccine hesitancy dimensions using a recently developed conceptualization. We achieve these goals by conducting a cross-sectional study with 404 participants (Agemean = 37.64; AgeSD = 14.91; 57% female; 72% white; 100% located in U.S.). Our results show that provider conversations and political orientation had the most consistent and strong effects of the personal characteristics, whereas perceptions that vaccines pose health risks and perceptions that vaccines are not needed for healthy individuals produced the most consistent and strong effects of the vaccine hesitancy dimensions. Other personal characteristics and vaccine hesitancy dimensions also produced intermittent significant effects, including age, education, and race. Together, these results support that personal characteristics and vaccine hesitancy dimensions relate to a broader range of outcomes associated with HPV vaccination than previously known, and these results also support that the recently developed conceptualization of vaccine hesitancy is apt for understanding HPV vaccine perceptions. Our discussion concludes with highlighting avenues for future research and practice that can leverage our discovered relations to improve HPV vaccination outcomes. [ABSTRACT FROM AUTHOR]

Gender has been identified as a social determinant of health, particularly as it relates to healthcare access for women of color. Yet, few analyses focus on the unique barriers that impact Latinx women's access to healthcare, which demonstrates a significant gap in the literature given the heterogeneity of the Latinx population. The purpose of this study is to (1) describe how sociodemographic characteristics impact access to healthcare for Latinx women and (2) examine whether intersecting factors, particularly nativity and nationality, influence barriers to healthcare for Latinx women in the United States (US). An outcome variable called 'any barriers to care' was created based on four healthcare access variables: lacking a usual source of care and delayed care (medical, dental and prescription). Data were from the Medical Expenditure Panel Survey (2005–2015). The sample included Latinx women between ages 18 and 74 (N = 27,162), cross-classified by nationality and nativity. Control variables included language, age, marital status, education, income, and insurance status. Multivariate logistic regression models were used to assess nativity and nationality as a predictor of any barriers to care. 37% of the sample experienced at least one barrier to care. Initially, nativity status was not a predictor of having a barrier to care. However, in adjusted models with cross-classified nativity and nationality variables, Mexican (US- and foreign-born), Cuban (US- and foreign-born) and Central/South American women (foreign-born only) had higher odds of having any barriers to care compared to continental US-born Puerto Rican women. Latinx women experience barriers to healthcare, yet the prevalence rates vary widely depending on nationality and nativity. It is important to recognize the heterogeneity that exists within the Latinx community and address the underlying causes for limited healthcare access such as immigration policy. [ABSTRACT FROM AUTHOR]

Our paper empirically examines how the decision to purchase private insurance and hospitalization are made based on household income, socio-demographic factors, and private health insurance factors in both Japan and the USA. Using these two data-sets, we found some similarities and dissimilarities between Japan and the United States. As income of households rises, households have a positive effect on purchasing health insurance as a normal good. Another similarity between the two countries is seen in the income effect on risk of hospitalization, which is negative for both Japanese and US cases. For dissimilarity, the insurance premium effect on risk of hospitalization is positive for the Japanese case, while negative for the US case. Since the Japanese insurance data had variables such as payments per day of hospitalization if household gets hospitalized, insurance payments upon death of an insured person, and annuity payments at maturity, we tested to see if these characteristics affect the risk of hospitalization for households; we do not eliminate a possibility of adverse selection. For the US pure health issuance characteristics, an increase in premium of health insurance policies cause individuals to substitute more health capital investment which causes lower risk of hospitalization. [ABSTRACT FROM AUTHOR]

Health policy in the United States struggles with apparently conflicting purposes: (1) access to health care and (2) cost-containment. The failures of policy to resolve this apparent conflict have produced inequities in the health system and the perverse outcomes of high costs and poor access. The failures of policy are associated with the third-party payment system that has become a "rationing transaction" in John R. Commons' hierarchy of transactions. The dominion of private interests over the payment system elevates the financial interests of insurers over the interests of patients. Commons' approach to "reasonable value" as a means of resolving conflicts of interest through a process that engages all participants in the going concern suggests a strengthened role for the public sector in the payment system to achieve the public purposes of the health system. [ABSTRACT FROM AUTHOR]

Background: To better understand what matters to African American elders who are faced with issues of death, dying, and end-of-life care, a qualitative study was conducted to elicit their perspective. Methods: Focus groups were convened across the state of Connecticut. A total of 196 individuals participated in the 90-minute interview sessions. Using an interview guide, a trained moderator conducted the racially homogeneous discussion groups. Transcriptions of the group narratives with 22 older African Americans were coded to identify themes. Data were organized and analyzed using NUD-IST 4 and constant comparative method of qualitative data analysis. Results: Five major themes emerged from the focus group data on older African Americans: (1) spirituality, (2) burden on family, (3) trust, (4) health insurance coverage, and (5) cultural concerns. Conclusion: Recommendations are made for outreach education, involvement of informal helpers, and a level of acceptability in practice for diverse care needs. [ABSTRACT FROM AUTHOR]

This study drew a nationally representative sample of U.S. low-wage hourly workers subject to the minimum wage mandates from the 2008 Survey of Income and Program Participation (SIPP) and estimated the prevalence of minimum wage violations in two unique ways. The incidence of experiencing violations was also modeled to examine the relative importance of workers' vulnerabilities and their employment characteristics in determining the incidence. Findings revealed that as much as 24 to 32% of the sample experienced the violations in the United States depending on the estimation method. Findings also provided empirical evidence missing in the literature: Union membership and employment-based health insurance coverage significantly reduce the odds of experiencing violations, while part-time employment increases the odds. An indicator of a fissured employment relationship, however, was found insignificant to experiencing the violations. [ABSTRACT FROM AUTHOR]

The article focuses on job creation in the U.S. and its impact on health insurance policy. The simple fact is that most of the uninsured are employed by small businesses. The argument made by the small business lobby is straightforward. Small business creates all the jobs, or the vast majority of jobs, and mandating employer health insurance will destroy jobs and lead to unemployment. The U.S. Small Business Administration and conservative politicians have long made grossly distorted claims about the role of small business in job generation. According to them, small business creates all the jobs. What is at stake in this job-generation claim is no less than the economic well being of millions of Americans. Whether the issue is minimum-wage legislation, taxes, environmental regulations, or mandated employer health insurance benefits, the small business job-generation argument is made. Since 1979 the claim "small business creates all the new jobs" or "small business creates 91 percent of the jobs" has become the mantra of both political parties.

Refugee women experience disproportionally high cervical cancer-related mortality. In this integrative review, we identify and discuss factors related to cervical cancer screening among refugee women in the US according to the Social Ecological Model. Two qualitative and three quantitative studies met inclusion criteria. Individual-level factors include English-language ability, availability, and individual knowledge, attitudes, and beliefs. Interpersonal-level factors include interactions with family/friends, provider, and community health worker. Community-, organization-, and policy-level factors include sociocultural values, transportation, ability to navigate the healthcare system, and health insurance. We discuss findings in the context of related reviews and applicability to other global settings. [ABSTRACT FROM AUTHOR]

The US health care system, characterized by high costs and limited health benefits coverage, is constantly undergoing reform. This paper presents a brief overview of the US health care system and its current reform: the use of managed care and medical savings account plans; reducing Medicare and Medicaid spending; and the regulation of managed care system. [ABSTRACT FROM AUTHOR]

In this paper, a micro-simulation model is developed to explain and estimate the optimum Medigap insurance coverage for elderly with different levels of insurance premium subsidy. The Medigap risk exposure is estimated from the 1977 National Medical Care Expenditure Utilization Survey, utilizing the gamma distribution. The theory of expected utility maximization is assumed and the model for health insurance demand is operationalized for hypothetical parameters for risk aversion, the price elasticity of demand, the loading fee and the subsidy. With the risk-aversion parameter at 0.0005, the price elasticity of medical-care demand at --0.5, loading costs at 9%, without any subsidy, the optimal Medigap co-insurance rate is 0.78; and with a premium subsidy of 60%, the co-insurance rate falls to 12%. The hypothetical price elasticity of demand for Medigap insurance is estimated to be between --0.44 and -- 1.02. More than half of the increase in medical expenditure resulting from an increase in premium subsidy from 0.35 to 0.60 is a welfare loss. [ABSTRACT FROM AUTHOR]

This paper tests the hypothesis of market disequilibrium and supplier-induced demand in the market for physicians services using Canadian data from the period prior to the introduction of National Health Insurance. The results support the hypothesis of disequilibrium, with rapid upward adjustment of fees in the face of excess demand and extremely slow downward adjustment of fees in response to excess supply. They do not support the hypothesis that physicians induced demand in the face of an excess supply of services. [ABSTRACT FROM AUTHOR]

In a major reform addressing declines in coverage over the prior decade, Congress in 1986 allowed states to expand Medicaid eligibility to all pregnant women in poverty. However, at the outset of the expansions uncertainty existed as to whether eligibility expansion alone would result in greater coverage without aggressive outreach designed to bring more low-income pregnant women into the program. Using interrupted time series methods, the analyses presented in this paper show a significant increase in Medicaid financing of deliveries in two states that expanded eligibility and also made efforts to simplify application procedures and publicize the expansions. Policy implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

This paper investigates the relationships among selected SEA measures and Medicare reimbursement. The findings generally indicate that those hospitals most heavily reliant on Medicare reimbursement are characterized by different levels of service efforts and accomplishments than other hospitals. The empirical analysis also provides evidence of a linkage between SEA measures arid market measures of the risk associated with bonds issued by the sample hospitals. [ABSTRACT FROM AUTHOR]

Costs, quality, and access are the central themes in health care policy in the United States. In the l980s the predominate issue is becoming access, and the likelihood for universal health coverage, or a national health insurance program, is growing. This paper explores how the America health care system got to this point and examines the present conditions, the trends, and the consequences of those trends. [ABSTRACT FROM AUTHOR]

Bhutanese refugees in the U.S. often struggle to access culturally competent health treatment. Addressing this problem requires understanding how refugees perceive their health and healthcare needs. Since 2015, a community agency has implemented community-based, peer-led support groups for Bhutanese refugees, with 17 groups in 2018-2019. This study describes the agency's quality assurance evaluation through group leader feedback, observation reports, and focus groups. The results of 46 quality assurance documents show that this group of Bhutanese refugees perceive their health through the mind-body connection, viewing physical and mental health as linked and supported by yoga, mindfulness, exercise, nutrition, and creative expression. [ABSTRACT FROM AUTHOR]

This study explores racial/ethnic inequalities in work-related injuries among U.S. construction workers. Data from the 2004–2017 National Health Interview Survey were used to estimate work-related injuries by race/ethnicity in construction. Disparities in demographic, socioeconomic, and injury status among construction workers were examined by race/ethnicity. Injury differences were also evaluated in multiple logistic regression analyses controlling for potential confounders. Compared to white, non-Hispanic workers, minority workers were more likely to have lower socioeconomic statuses (e.g., lower educational attainment, lack of health insurance coverage, and family income below the poverty level), which considerably increased the likelihood of work-related injuries. The odds of work-related injuries were 70% higher among racial/ethnic minorities than white, non-Hispanics in construction. Injuries were also more severe among minorities than white, non-Hispanic workers. Among workers with a work-related injury, nearly 85% of Hispanics reported missing at least one workday due to injury, 45.6% higher than the proportion of 57.9% for their white, non-Hispanic counterparts. After adjusting for major demographic and socioeconomic factors, the work-related injury difference between race/ethnicity was no longer statistically significant. However, the odds of work-related injury remained significantly higher among workers who were younger (35–54 years vs. ≥ 55 years: aOR = 2.2, 95% CI: 1.3–3.6); male (aOR = 5.3, 95% CI: 2.9–9.8); not college-educated (aOR = 1.5, 95% CI: 1.0–2.2); had a family income below the poverty threshold (aOR = 1.8, 95% CI: 1.2–2.8); or held a blue-collar occupation (aOR = 2.0, 95% CI: 1.2–3.4). These findings suggest that the injury differences between race/ethnicity were strongly associated with demographics and socioeconomic inequalities in these worker groups. The identified injury disparities should be reduced or eliminated, following the hierarchy of controls paradigm. [ABSTRACT FROM AUTHOR]

Achieving a high-quality health system is a complicated journey. Countries employ distinct approaches and build upon lessons learned along the way. Several wealthy industrialized countries have had measurable success advancing the quality of health care provided to their people. In contrast, many developing countries are still endeavoring to identify and implement robust strategies to promote quality health care. By observing the challenges and successes experienced by industrialized nations, developing countries can identify effective methods to advance the quality of their health care systems while avoiding known obstacles. This article describes approaches pursued by the United States and Egypt to advance the quality of their respective health care systems. Contrasting each country's health care initiatives highlights various quality improvement methods that have been undertaken and how one country's experience can inform other countries striving to implement similar efforts. [ABSTRACT FROM AUTHOR]

Insurance company case managers can play a critical role in the rehabilitation process of people with musculoskeletal disorders sustained following minor motor vehicle crash injury due to their interaction with multiple stakeholders and their role in approving various services. This study aimed to identify factors that case managers perceive as predictive of recovery in people with musculoskeletal disorders after minor motor vehicle crash injury. To explore the perspectives of cases managers in Australia and the United States, semi-structured interviews explored factors that case managers thought provided an early indication of likely recovery outcomes in people with musculoskeletal disorders after minor motor vehicle crash injury. A framework analysis was applied and factors were displayed within the ICF-framework. Case managers (n = 40) demonstrated a broad, detailed understanding of biopsychosocial and contextual issues influencing recovery. They emphasized the importance of the injured worker's expressed affect and motivation, style of communication, the role of lawyers, the worker's family and friends, as well as cultural and geographic influences. The overarching themes perceived as having a major influence on recovery outcomes were general health, pain processing and response, work situation, and compensation entitlement. Case managers' broad and detailed perceptions about recovery may provide additional, valuable perspectives for professionals involved in the rehabilitation process of people with musculoskeletal disorders after minor motor vehicle crash injury. Further research needs to be conducted to explore the effects of case manager involvement in the process of recovery. Insurance Case Managers identified multiple factors including affect and motivation, style of communication, the role of lawyers, family and friends, cultural and geographic variation provide opportunities for more effective treatment of people with musculoskeletal disorders related to minor motor vehicle collisions. These managers' perceptions about recovery may be informative to and provide opportunities for health professionals involved in the rehabilitation of people with musculoskeletal disorders related to minor motor vehicle collisions. While the Insurance Case Managers involved in this research did not use formalized assessment techniques, tools and assessment protocols could be developed jointly between for the needs of Insurance Case Managers and other stakeholders to tackle recovery of people with musculoskeletal disorders related to minor motor vehicle collision. [ABSTRACT FROM AUTHOR]

Our paper empirically examines how the decision to purchase private insurance and hospitalization are made based on household income, socio-demographic factors, and private health insurance factors in both Japan and the USA. Using these two data-sets, we found some similarities and dissimilarities between Japan and the United States. As income of households rises, households have a positive effect on purchasing health insurance as a normal good. Another similarity between the two countries is seen in the income effect on risk of hospitalization, which is negative for both Japanese and US cases. For dissimilarity, the insurance premium effect on risk of hospitalization is positive for the Japanese case, while negative for the US case. Since the Japanese insurance data had variables such as payments per day of hospitalization if household gets hospitalized, insurance payments upon death of an insured person, and annuity payments at maturity, we tested to see if these characteristics affect the risk of hospitalization for households; we do not eliminate a possibility of adverse selection. For the US pure health issuance characteristics, an increase in premium of health insurance policies cause individuals to substitute more health capital investment which causes lower risk of hospitalization. [ABSTRACT FROM AUTHOR]

Focused on the health literacy of two subgroups of Asian immigrants, Korean (N = 118) and Vietnamese (N = 105), this study examines the interrelationships among demographics, health literacy, self-perceived health status, and quality of life using structural equation modeling. Findings suggest that, although often labeled as Asian immigrants as an aggregate in the health literature, immigrants from Korea and Vietnam report significant differences in areas of demographics (age, citizenship, time in the US, education, marital status, English proficiency, and health insurance), utilization of health services (mammogram screening, pap smear, colorectal screening, visit to doctors), health literacy, and self-perceived health status, representing their own unique ethnic and immigration status. As hypothesized, for both Korean and Vietnamese immigrants, demographics (especially English proficiency) influence health literacy, which in turn affects self-perceived health status and quality of life. Self-perceived health status also directly affects quality of life. Therefore, health communication and interventions should focus on improving health literacy and alleviating health literacy disparities, which could increase the well-being and QOL among subgroups of Asian immigrants. [ABSTRACT FROM AUTHOR]

To provide nationally representative estimates of adults with traumatic brain injury (TBI) and identify clusters of individuals with TBI who follow similar perceived health trajectories using group-based trajectory modeling. Adults (≥18 years old) from panels 9–19 (2004–2015) of the Medical Expenditure Panel Survey (MEPS) who experienced a TBI (n = 949). Data from MEPS, a nationally representative database of noninstitutionalized individuals in the USA, were used to 1) produce a national annual estimate of adults with TBI and 2) identify subgroups of patients with TBI who followed different general and mental health trajectories. Perceived general health (PGH), perceived mental health (PMH) On average, 502 adults per 100,000 noninstitutionalized US adults experienced a TBI annually, and about one million adults are living with a TBI. Three distinct trajectory groups were identified in models of both perceived general health (PGH) and perceived mental health (PMH). TBI type, sex, and persistent disability predicted assignment to a group in the PGH model. TBI type, sex, age, insurance status, family poverty status, and persistent disability predicted assignment to a PMH trajectory. Referrals and early-intervention resources should be distributed to individuals with increased risk of following low PGH and/or PMH trajectories. [ABSTRACT FROM AUTHOR]

Health insurance companies have an interest in understanding what factors may lead to positive word-of-mouth (WOM) from consumers. This research identifies factors that influence positive WOM about health insurance firms. Using data collected from 425 insurance policy holders, we find influential factors vary depending on the purchase source. Significant factors identified in the study that influence positive word-of-mouth include service quality, plan satisfaction, and plan type (individual vs. family). Further, claim count, preferred information source, and deductible levels also affect the spread of positive WOM differently among purchase sources. The study concludes with a discussion of implications and future research. [ABSTRACT FROM AUTHOR]

This study examines the trajectories of mental health across baby boomers to understand their mental health during middle age. This study used secondary data from the National Longitudinal Survey of Youth 1979 (NLSY79) and used four points in time to estimate trajectories of mental health during adulthood. This study included 834 participants who were born in 1959. The Latent Growth Curve Model (LGCM) was used for modeling and estimating the trajectories of mental health. The trajectories of mental health show non-linear change even after considering longitudinal changes of variables. The trajectories indicate a V-shaped curve: higher depression at 34 and 50 years of age and the lowest depression at 40 years. Males predicted lower intercepts of depression and those with higher self-esteem showed lower depression initially. This study provides further evidence for understanding baby boomers' mental health during their adulthood within a longitudinal setting by using a nationwide sample. More specialized interventions and services should be considered for females' mental health problems over time. It is also important to help individuals develop and cultivate their self-esteem before entering into middle age. [ABSTRACT FROM AUTHOR]