Search

Background: Whether variation in Medicaid reimbursement fees influenced the impacts of the Medicaid expansions is not well understood. Objective: We examine whether changes in health care access associated with Medicaid expansion are different in states with comparatively high Medicaid reimbursement rates compared against expanding in states with lower Medicaid reimbursement rates. Design: Using a difference-in-difference-in-difference (DDD or triple-difference) regression approach, we compare relative differences in Medicaid expansion effects between lower and higher reimbursement states. Participants: 512,744 low-income adults aged 20–64 in the 2011–2019 Behavioral Risk Factor Surveillance System. Main Measures: Health insurance coverage status, unmet medical needs due to cost, regular source for health care, and a regular/scheduled checkup within the past year. Key Results: Medicaid expansion has significant and positive impacts on health coverage and access in both high- and low-fee states. In states with fee levels above the median Medicare-to-Medicaid ratios, expanding Medicaid eligibility reduced uninsurance rate by 15.2 percentage point (ppt, p < 0.01), shrank the cost-associated unmet medical need by 10.3 ppt (p < 0.01), improved access to usual source of care by 1.9 ppt (p < 0.1), and increased regular checkup by 14.4 ppt (p < 0.01), while such effects in low-fee states were 11.7 ppt (p < 0.01), 8.3 ppt (p < 0.01), 3.1 ppt (p < 0.1), and 12.3 ppt (p < 0.01), respectively. Our results suggest that Medicaid expansion effect on unmet medical need due to cost in higher-reimbursing states was 2.98 ppt (p < 0.05) larger than in lower-reimbursing states. Evidence suggests modest increases in health care access were more strongly associated with expansions in higher-fee states. Conclusions: Medicaid's fee structure should be considered as a factor influencing large-scale coverage expansions. [ABSTRACT FROM AUTHOR]

The high cost of medical care and its association with poverty have given rise to a growing concern for developing countries, but how insurance plans affect household income and alleviate poverty has been rarely discussed. This study aims to bridge this research gap by examining a medical insurance reform in China, a major program of the targeted poverty alleviation (TPA) strategy, which offers higher reimbursement rates and lower medical deductibles for low‐income households. We use an administrative data set on impoverished people in a Chinese county to examine how exogenous changes in the medical insurance system affect the income structure of low‐income households. We apply a two‐part model to a Difference‐in‐Differences framework, with households that received reimbursement of the insurance reform as the treatment group and others as the control group. Our results imply that the medical insurance reform could increase the overall household income diversity. The mechanism analysis suggests that the medical insurance reform improves the health conditions of patients and encourages caregivers to engage more in off‐farm work. [ABSTRACT FROM AUTHOR]

As health care costs rise in Australia, the affordability of primary care and private health insurance (PHI) are critical concerns. Key questions include whether primary care should be free for all, and what role should PHI play alongside Medicare. The Government spends $6.7 billion on PHI rebates, yet these incentives have limited impact. The Government should reduce public support on PHI and improve primary and preventive care. Primary care should be free for all low‐income people and children regardless of where they live, and cheaper for other population. This can be achieved with the current budget and better policy design. [ABSTRACT FROM AUTHOR]

Background and Aims: Impoverished people who inject drugs (PWID) are at the epicenter of US drug‐related epidemics. Medicaid expansion is designed to reduce cost‐related barriers to care by expanding Medicaid coverage to all US adults living at or below 138% of the federal poverty line. This study aimed to measure whether Medicaid expansion is (1) positively associated with the probability that participants are currently insured; (2) inversely related to the probability of reporting unmet need for medical care due to cost in the past year; and (3) positively associated with the probability that they report receiving substance use disorder (SUD) treatment in the past year, among PWID subsisting at ≤ 138% of the federal poverty line. Design: A two‐way fixed‐effects model was used to analyze serial cross‐sectional observational data. Setting: Seventeen metro areas in 13 US states took part in the study. Participants: Participants were PWID who took part in any of the three waves (2012, 2015, 2018) of data gathered in the Center for Disease Control and Prevention's National HIV Behavioral Surveillance (NHBS), were aged ≤ 64 years and had incomes ≤ 138% of the federal poverty line. For SUD treatment analyses, the sample was further limited to PWID who used drugs daily, a proxy for SUD. Measurements State‐level Medicaid expansion was measured using Kaiser Family Foundation data. Individual‐level self‐report measures were drawn from the NHBS surveys (e.g. health insurance coverage, unmet need for medical care because of its cost, SUD treatment program participation). Findings The sample for the insurance and unmet need analyses consisted of 19 946 impoverished PWID across 13 US states and 3 years. Approximately two‐thirds were unhoused in the past year; 41.6% reported annual household incomes < $5000. In multivariable models, expansion was associated with a 19.0 [95% confidence interval (CI) = 9.0, 30.0] percentage‐point increase in the probability of insurance coverage, and a 9.0 (95% CI = −15.0, −0.2) percentage‐point reduction in the probability of unmet need. Expansion was unrelated to SUD treatment among PWID who used daily (n = 17 584). Conclusions: US Medicaid expansion may curb drug‐related epidemics among impoverished people who inject drugs by increasing health insurance coverage and reducing unmet need for care. Persisting non‐financial barriers may undermine expansion's impact upon substance use disorder treatment in this sample. [ABSTRACT FROM AUTHOR]

Background: Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojna (AB-PMJAY) as a financial risk protection scheme intends to reduce catastrophic health expenditure (CHE), especially among poor. The current study was carried out to assess the utility of AB-PMJAY in terms of reduction in CHE from before and after admission in a tertiary hospital in the northern state of India. Methodology: It was a hospital-based cross-sectional study carried out from August 2020 to October 2021 at a public tertiary hospital of Himachal Pradesh, India. Data were collected from surgery- and medicine-allied (SA and MA) specialties. Along with socio-demographic details, information for total monthly family expenditure (TMFE), out-of-pocket expenditure (OOPE), and indirect illness-related expenditure (IIE) was recorded before and after hospital admission. CHE was considered as more than 10.0% OOPE of THFE and more than 40.0% of capacity to pay (CTP). Results: A total of 336 participants with a mean age of 46 years were recruited (MA: 54.6%). The majority (-93.0%) of participants had illness of fewer than 6 months. The mean TMFE was observed to be INR 4213.1 (standard deviation: 2483.7) and found to be similar across specialties. The OOPE share of TMFE declined from 76.1% (before admission) to 30.0% (after admission). Before admission, CHE was found among 65.5% (10.0% of THFE) and 54.2% (40.0% of CTP) participants. It reduced to about 29.0% (based on both THE and CTP) after admission to hospital. Conclusion: AB-PMJAY scheme found to be useful in reducing CHE in a tertiary hospital. [ABSTRACT FROM AUTHOR]

Pantawid Pamilyang Pilipino Program (4Ps) is the Philippine version of the conditional cash transfer (CCT) program that measures human development through the provision of conditional cash grants to the poorest of the poor. This research determines the health expenditure and utilisation of the poor families in a low-income community under the CCT program. A cross-sectional research design was adopted using mixed methods of data collection from 177 households between May and June 2017. Results reveal that most families under CCT devote the largest portion of household health expenditure for inpatient health seeking. About 40% of the total expenditure is covered by the National Health Insurance Program and the cost for hospitalisation mostly comes from the out-of-pocket source. Moreover, the common problems encountered during health utilisation and spending are poor customer service of healthcare facilities and uncompensated hospital bill by health insurance. [ABSTRACT FROM AUTHOR]

Insurance coverage increases health care consumption, but less is known whether moderate copayments affect adults' primary care utilization in a system characterized by gatekeeping. We analyze whether abolishing a 14-euro copayment for visits to general practitioners (GP) in Helsinki, the capital of Finland, increased the number of GP visits among adults and especially among low-income individuals. Using a difference-in-differences (DD) design and combining several administrative registers from 2011 to 2014, we find that the abolition is associated with only a small increase in GP visits (+0.04 visits annually, or +4.4 %, for all adults). The increase is driven by low-income adults (+0.06 visits, or +4.5 %, at the bottom 40 %). Although the point estimates are rather robustly positive, the conclusions regarding the statistical significance are sensitive to how we account for clustering in a setting characterized by only one treated cluster and a finite number of comparison clusters. [ABSTRACT FROM AUTHOR]

This document is a response to a letter regarding the article "Health Poverty Alleviation Project in Rural China: Impact on Poverty Vulnerability, Health Status, Healthcare Utilization, Health Expenditures." The authors express gratitude for the readers' interest and comments on their research. They defend the robustness and rigor of their findings, highlighting the use of valid estimation methods and reliable assessment methodologies. The authors clarify the target group of the policy and emphasize the focus of their study on evaluating the effectiveness of the government's implementation of the project. They also discuss the distinction between ex ante and ex post moral hazard and suggest future research directions for health policy evaluation. The study was supported by grants from the National Social Science Fund of China. The authors declare no conflicts of interest. [Extracted from the article]

The purpose of this study is to explain the construction of the Indonesian national health insurance policy model for the poor and its theoretical and practical implications for the implementation of the Indonesian national health insurance policy for the poor. This study used qualitative research methods. Meanwhile, data collection used in-depth interviews, observation, and document studies. Data analysis consists of data reduction, data display, conclusions drawing, and verification. The construction model of the Indonesian national health insurance policy produces several important aspects that interact with each other, namely the apparatus performance patterns, apparatus capabilities, bureaucratic culture, political interests, principles of universality, and financing of health coverage. Theoretically, the Indonesian national health insurance policy has implications for a broader dimension, such as political, legal, economic, social, and cultural. In addition, it touches on a philosophical dimension, concerning the rights of citizens, such as civil rights, political rights, and social rights. Meanwhile, practically, it is related to the development of health resources, improvement of the population administration system, financing, and quality and cost control. [ABSTRACT FROM AUTHOR]

India's health care suffers from high out-of-pocket medical expenses that lead to a higher financial burden on poor people. To reduce the health cost burden, the government of India has initiated many governments funded insurance schemes since 2000. Private health insurance also flourished, but the coverage is limited to wealthier households. Many researchers have published many scientific publications on this research domain, but the bibliometric analysis of scientific publications is missing. We have relied on the 'SCOPUS' database for data collection based on the wider availability of literature. 761 documents extracted were journal articles, published between 2000 and 2021 followed by certain inclusion and exclusion criteria. Biblioshiny package of R-Studio has been used for data analysis. Our analysis reflect upon various aspects of Bibliographic analysis like number of articles published, cited, country wise scientific production etc. Our results also reflect on very few studies that relate to Poverty, income, young adults, aged, adolescents, and children, where there is further scope for research. We found that the health insurance-related publication rate has increased over the period. But it requires more research especially the implementation of health insurance mechanisms from the health system perspective. The study will be a policy document to find the research gaps in the healthcare insurance domain. [ABSTRACT FROM AUTHOR]

To achieve a tiered healthcare system in China, the government has beefed up efforts to encourage people to embrace private health insurance. One of the steps is to introduce tax-subsidized health insurance (TSHI) in 2015. This paper assesses whether TSHI is successful in improving health and easing financial burden. Using unique data from the Domestic TSHI Consumers Evaluation Survey in 2019 and Propensity Score Matching method, we find that TSHI has been effective in improving participants' health status, but not in lowering out-of-pocket (OOP) burden. Besides, TSHI can increase the utilization of both inpatient and outpatient care, which provides a possible explanation for beneficial health effect. From an internal perspective, TSHI has the potential to reduce disparities in health and access to healthcare services. Our results provide implications on modifying the benefit design of TSHI to better complement basic medical insurance system and on reforming the current tax incentive policy to reach out a large number of low-income people. [ABSTRACT FROM AUTHOR]

The article focuses on the speaker Gina Hinojosa, Texas Representative for District 49. Topics include talks about COVID-19 pandemic and the way it affects the Latinx community; and considered after the acute emergency of the COVID-19 several precautions have been used in various ways to take just to survive right.

Policymakers seeking to target health policies efficiently towards specific population groups need to know which individuals stand to benefit the most from each of these policies. While traditional approaches for subgroup analyses are constrained to only consider a small number of pre-defined subgroups, recently proposed causal machine learning (CML) approaches help explore treatment-effect heterogeneity in a more flexible yet principled way. Causal forests use a generalisation of the random forest algorithm to estimate heterogenous treatment effects both at the individual and the subgroup level. Our paper aims to explore this approach in the setting of health policy evaluation with strong observed confounding, applied specifically to the context of mothers' health insurance enrolment in Indonesia. Comparing two health insurance schemes (subsidised and contributory) against no insurance, we find beneficial average impacts of enrolment in contributory health insurance on maternal health care utilisation and infant mortality, but no impact of subsidised health insurance. The causal forest algorithm identified significant heterogeneity in the impacts of contributory insurance, not just along socioeconomic variables that we pre-specified (indicating higher benefits for poorer, less educated, and rural women), but also according to some other characteristics not foreseen prior to the analysis, suggesting in particular important geographical impact heterogeneity. Our study demonstrates the power of CML approaches to uncover unexpected heterogeneity in policy impacts. The findings from our evaluation of past health insurance expansions can potentially guide the re-design of the eligibility criteria for subsidised health insurance in Indonesia. [ABSTRACT FROM AUTHOR]

English Abstract: The article starts with puzzlement about the optimism of a new generation of (Indian) policy-makers who believe that investing in digitally managed publicly funded health insurance (PFHI) schemes can dramatically improve health security in India, provide poor people with seamless access to high-quality hospital care and contribute significantly towards achieving universal health coverage. In view of persistent high social inequality and dissatisfaction with the chronically underfunded medical system, this optimistic vision appears as a curious utopia, not least because it survives multiple failures and heavy critique. Fine-grained ethnography shows that in practice the ambitious transformation of health finance, via the operation of national health insurances projects, was slow to be established and plagued by myriad technical and administrative frictions, and its impact on wellbeing and sustainability has been heavily contested. By zooming into the nitty-gritty of the laborious roll-out of a project with dramatically new features, this article illustrates that hope for transformation emerges less from successful implementation than from the determination to keep trying – seeking improvement through tweaking the system and reforming policy. Welfare in this iteration is an experimental engagement with future-making. As such, it does not promise effective management per se; rather, it demands investment in an uncertain journey, cobbled together by tinkering, adjusting, reforming and re-regulating. French Abstract: Cet article commence par une certaine perplexité face à l'optimisme d'une nouvelle génération de décideurs politiques qui pensent qu'investir dans des régimes d'assurance maladie à fimancement public (PFHI) gérés numériquement peut améliorer considérablement la sécurité sanitaire en Inde, peut offrir aux pauvres un accès transparent à des soins hospitaliers de qualité, et peut contribuer de manière significative à la réalisation de la couverture sanitaire universelle (CSU). Comptetenu de la persistance de fortes inégalités sociales et du mécontentement à l'égard du système médical chroniquement sous-financé, cette vision optimiste apparaît comme une curieuse utopie, notamment parce qu'elle survit à de multiples échecs et à de lourdes critiques. Une ethnographie fine montre que, dans la pratique, la transformation ambitieuse du financement de la santé a été lente à se mettre en place, qu'elle a été en proie à une myriade de frictions techniques et que son impact sur le bien-être et la durabilité a été fortement contesté. En s'attardant sur les détails du déploiement laborieux d'un projet aux caractéristiques radicalement nouvelles, l'article montre que l'espoir d'une transformation naît moins d'une mise en œuvre réussie que de la détermination à continuer d'essayer – en cherchant à améliorer le système et à réformer la politique. L'aide sociale, dans cette itération, est un engagement expérimental dans la construction de l'avenir. En tant quetel, il ne promet pas une gestion efficace en soi; il exige plutôt un investissement dans un voyage incertain, bricolé en bricolant, en ajustant et en réformant. [ABSTRACT FROM AUTHOR]

The article informs that High-deductible health plans (HDHPs) have proliferated in recent years, as they have been increasingly adopted by employers seeking to rein in health care cost increases. Topics include private-sector employees with single coverage, 57.7 percent are enrolled in an HDHP; and HSA-eligible HDHPs are also available via Affordable Care Act (ACA) exchanges.

Objective: To describe prevalence, trends, and risk factors for catastrophic health expenditures in the year of delivery among birth parents (delivering people).Methods: We conducted a retrospective, cross-sectional study of the Medical Expenditure Panel Survey from 2008-2016. We identified newborn birth parents and a 2:1 nearest-neighbor propensity-matched control cohort of nonpregnant reproductive-aged individuals, then assessed for catastrophic health expenditures (spending greater than 10% of family income) in the delivery year. We applied survey weights to extrapolate to the noninstitutionalized U.S. population and used the adjusted Wald test for significance testing. We compared risk of catastrophic health expenditures between birth parents and the control cohort and described time trends and risk factors for catastrophic spending with subgroup comparisons.Results: We analyzed 4,056 birth parents and 7,996 reproductive-aged females without pregnancy in a given year. Birth parents reported higher rates of unemployment (52.6% vs 46.6%, P<.001), and high rates of gaining (22.4%) and losing (25.6%) Medicaid in the delivery year. Birth parents were at higher risk of catastrophic health expenditures (excluding premiums: 9.2% vs 6.8%, odds ratio [OR] 1.95, 95% CI 1.61-2.34; including premiums: 21.3% vs 18.4%, OR 1.53, 95% CI 1.32-1.82). Birth parents living on low incomes had the highest risk of catastrophic health expenditures (18.8% vs 0.7% excluding premiums for 138% or less vs greater than 400% of the federal poverty level, relative risk [RR] 26.9; 29.8% vs 5.9% including premiums, RR 5.1). For birth parents living at low incomes, public insurance was associated with lower risks of catastrophic health expenditures than private insurance, particularly when including premium spending (incomes 138% of the federal poverty level or lower: 18.8% public vs 67.9% private, RR 0.28; incomes 139-250% of the federal poverty level: 6.5% public vs 41.1% private, RR 0.16). The risk of catastrophic spending for birth parents did not change significantly over time from before to after Affordable Care Act implementation.Conclusion: Pregnancy and delivery are associated with increased risk of catastrophic health expenditures in the delivery year. Medicaid and public coverage were more protective from high out-of-pocket costs than private insurance, particularly among low-income families. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to find funding sources for social health insurance in Sudan to cover vulnerable families. Design/methodology/approach: The concept of this paper is to look into the causality relationship between insured and directly paid poor people and their incomes through using the autoregressive distributed lag model (ARDL) and using a survey raw data carried out in 2010 in Sudan. Findings: The findings show that insured vulnerable people and income-generating activities have a significant positive relationship. The results, on the other hand, show a marginally negative effect on income for those who have directly paid poor people. Originality/value: Previous research on the position of zakat has focused primarily on its role in poverty alleviation and has given little consideration to its role in social security. This study is characterized by improving the possibility of changing the mechanism of distributing zakat funds in favor of health financing to maximize the benefit. [ABSTRACT FROM AUTHOR]

Abstract Recent expansions of Medicaid eligibility have come with increased experimentation with enrollee cost-sharing. In this paper, we exploit a discontinuous premium increase at the federal poverty level in Michigan's Medicaid expansion program to test low-income individuals' sensitivity to premiums using linked enrollment and claims data. At the cutoff, average premiums increase by $3.15 and the probability of disenrollment increases by 2.3 percentage points. Increased disenrollment occurs among those with fewer documented medical needs at baseline, but not among those with greater medical needs. These results suggest that healthier low-income individuals may be sensitive to even modest health insurance premiums, and that premiums may induce adverse selection in Medicaid plans. [ABSTRACT FROM AUTHOR]

Limited availability and accessibility of the public health care facilities have resulted in an increased burden of financing healthcare in developing countries. Therefore, we analyse the inpatient-care financing strategies in India using healthcare and morbidity rounds (1994/1995, 2004, and 2014). Although income and saving is the predominant source of financing healthcare expense constituting a major channel in 70% of the inpatient episodes; the poorest 40% of the households rely more on borrowings, which pushes low-income families into debt and poverty trap. The educated, wealthy, and female tend to rely more on income/saving, while a greater number of visits to the hospital, long duration of stay, and chronic illness are positively associated with the borrowing and sales of assets. Hence, the health care policy, guided by the agenda of Universal Health Cover, should aim to extend health insurance for the chronic recurring illnesses that entail distressed financing strategies. [ABSTRACT FROM AUTHOR]

Objective: Metabolic Syndrome (MetS) is a constellation of deleterious cardiometabolic health conditions (e.g., diabetes, hypertension) that have been linked to cognitive impairment and accelerated cognitive decline in older adults. Research has shown that Latinos are at increased risk for developing MetS relative to non-Latino Whites and the prevention, maintenance, and treatment of cardiometabolic risk factors are largely contingent upon health insurance status. Within the United States there are considerable state-based differences in eligibility and access to health insurance coverage. Although Texas has the second largest population of Latinos, they are one of the most underinsured groups within the state. There is some evidence to suggest that inconsistent healthcare is associated with cognitive impairment among underserved/underprivileged groups. The current study sought to examine whether insurance status moderates the association between MetS and cognitive functioning in an effort to inform public health policy initiatives vital to reducing age-related health disparities amongst Latino older adults residing in Texas. Participants and Methods: The study sample included 850 primarily Spanish-speaking (67.6%) Latino older adults (mean age = 63.1±7.81) largely of Mexican origin/descent (95%) enrolled in the Health and Aging Brain Study-Health Disparities. All participants completed neuropsychological testing, a health exam, and questions about health insurance coverage. MetS status (MetS+ vs. MetS-) was determined by abnormal clinical abdominal obesity, triglycerides, high-density lipoprotein, blood pressure, and fasting glucose values. Health insurance status was determined by current enrollment in any private or public insurance plan. Cognition was assessed with Digit Span, Logical Memory I and II, Trail Making Test (A and B), Spanish-English Verbal Learning Test, and Letter Fluency (FAS). Raw scores were converted to z-scores which were subsequently averaged into two distinct memory and executive functioning composite scores. ANCOVAs controlling for age, sex, education, APOE e4 positivity, annual income, and primary language status were used examine health insurance status x MetS interactions on cognitive composites. Results: Approximately 54.6% of the sample met clinical criteria for MetS+ and 23.6% endorsed having no health insurance. There were no significant group differences in the proportion of MetS+ and MetS- individuals with and without health insurance (X 2 =.002, p =.96). Results revealed there was a significant MetS x health insurance status interaction on the memory composite (F = 5.39, p =.02). Post-hoc comparisons revealed that Latino older adults without health insurance demonstrated poorer memory performance relative to those with health insurance in the MetS+ group (p=.02). In contrast, there were no significant differences in memory performance across insurance status in the MetS- group (p=.35). Finally, there was no significant MetS x health insurance interaction on executive functioning (p=.60). Conclusions: Findings revealed that health insurance coverage differentially impacts memory, but not executive functioning, amongst Latinos with MetS+. Underinsured Latinos with chronic cardiometabolic health conditions may be at risk for poor memory outcomes and increasing access to affordable healthcare could help mitigate the adverse effects of MetS+ on memory. Future studies examining the relationship between health insurance, MetS status, and neuroimaging markers may yield additional insight into mechanisms underlying age-related dementia disparities. [ABSTRACT FROM AUTHOR]

Background: Out of pocket (OOP) spending on health contributes significantly to levels of poverty in developing countries such as Pakistan. In poor countries there is reduced or limited access to health services, the issue of affordability and availability which all lead to impaired health status and increased morbidity and mortality rates in developing countries. Catastrophic health expenditure is not always synonymous with high health care costs; even small Out of pocket expenses may cause catastrophic condition for poor people. Methods: This is a cross sectional study that determined the out of pocket cost of computed tomography scan test (CT scan). The study was conducted from April to June 2015. The study population was those patients who came for CT scan at Hira medical center in district Sukkur Sindh Pakistan. The study sample was one hundred and seventy patients. (n=150). From the perspective of consumer the methodology was adopted, various recurrent costs were determined under different levels of input and cost canters. The data was entered and analyses using SPSS 20 to provide the results as percentages and averages for the different variables in this study. Results: Through this research we found that out of pocket payments are way too high while putting alot of burden on lower socioeconomic groups. Health expenditure Average cost per patient calculated were Rs. 11000 which means people spend more than 40% of their monthly income on health. There should be a government health facility in the city to compensate the huge cost which people pay for health especially low monthly income people. Conclusion: Government should introduce a health coverage insurance system in Pakistan in order to cover all health care needs of the people irrespective of their socioeconomic status. Keeping in view high out of pocket spending on health, the Government should subsidize the prices of diagnostic test to give relief to its Population. Community participation is also essential for sustainable solutions [ABSTRACT FROM AUTHOR]

Copyright of Bulletin of Indonesian Economic Studies is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Community-based health insurance is a not-for-profit type of health insurance that has been used by poor people to protect themselves against the high costs of seeking medical care and treatment for illness. This study aimed to assess communities' willingness to enroll for community-based health insurance (CBHI) and its associated factors in Simada district, Northwest, Ethiopia. Methods: A community-based mixed cross-sectional study design was conducted. Multistage simple random and purposive sampling techniques were used for quantitative and qualitative studies, respectively. Data were coded and entered into Epi info version 7.2.0.1 and exported to SPSS 20.0 for data analysis. Inferential statistics were done to determine an association between the outcome and independent variables. Statistically significant variables in binary logistic regression analysis with p-value < 0.2 were entered for multivariable binary logistic regression analysis and P-value ≤ 0.05 was considered as statistically significant. Hosmer and Lemeshow's goodness of fitness test was fitted and qualitative data were analyzed by using thematic analysis. Results: Among 510 study participants, 454 (89%) [CI: (86.5%-91.6%)] were willing to enroll for community-based health insurance. Members of social capital [AOR: 7.6 (3.78– 15.5)], distance from health facilities [AOR: 10.8 (4.9– 23.5)], the experience of chronic illness in the family [AOR: 4.6 (1.88– 11.4)], medium family wealth status [AOR: 3.1 (1.3– 7.5)], and the number of family members [AOR: 2.25 (1.11– 4.6)] were significantly associated with willingness to enroll for community-based health insurance. Conclusion: Willingness to enroll in community-based health insurance in the study area is high. Members of social capital, the experience of chronic illness in the family, distance from a health facility, the number of family members, and medium family wealth status were factors found to be associated with willingness to enroll for the scheme. Therefore, emphasizing redesigning and planning strategies for better expanding the scheme accordingly. [ABSTRACT FROM AUTHOR]

Marking the end of the five-year programme initiated by the Chinese Government to lift more than 70 million people out of poverty, the year 2020 is a milestone. Poverty alleviation has moved strongly forward in China and the major health indicators are now better than the average of all middle- and high-income countries. However, the dual burden of infectious and chronic diseases remains a challenge with respect to achieving the health target in the United Nations 2030 Agenda for sustainable development goals (SDGs). In 2015, about 44% of the poor population in China were impoverished by illness but already in 2018, multi-sectoral actions delivered by the Health-related Poverty Alleviation programme had reduced the number almost by half. In the past three years 15 million poor people (98% of the poor population) with infectious and chronic diseases had been treated and taken care of thanks to financial support through multiple health insurance schemes and other governmental subsidies. This article discusses the lessons learnt with regard to health-related poverty alleviation in China with special reference to those still remaining impoverished by illness. Consolidation of the achievements reached and provision of basic needs to those still disadvantaged and in poor health will require a major improvement of accessibility to, and affordability of, health services. The next step towards enhanced productivity and better living conditions will involve upgrading of the capacity of health professionals in the poor regions, promotion of coherent efforts in health-related poverty alleviation and rural revitalization measures. As an additional measure, data monitoring and research on health poverty alleviation should be strengthened as they are essential to generate the evidence and knowledge needed to support the move in the direction envisioned by the SDGs, and the new Healthy China 2030 programme. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate how the poor, relative to the wealthier, benefitted from recent improvements in health insurance coverage, maternity care utilisation (modern contraceptive use, antenatal care visits, facility delivery, and skilled birth attendants), and under-five mortality in Kenya. The analysis relies on the latest two waves of the Kenya Demographic and Health Survey and a theoretical framework with three different inclusiveness (pro-poorness) concepts. Our results are quite robust to pro-poorness concepts and poverty definitions. The main result is that the poor experienced larger improvements in all investigated health aspects compared to the rich (irrespective of the poverty concept) when changes are measured in relative terms. When we investigate changes in absolute terms, we find a similar pattern, except in the case of health insurance coverage and the presence of a skilled birth attendant during delivery. Our analysis is expected to inform policy-making aiming to achieve universal health coverage. [ABSTRACT FROM AUTHOR]

Objective: To obtain the perspectives of health professionals and community health workers on factors that determine health service coverage and maternal health outcomes so as to understand variations between districts. Methods: 16 Focus group discussions involving four different groups of participants were conducted in May 2015 in four purposively selected districts, complemented by three key informant interviews in one of the districts. Results: The solidarity support for poor people and the interconnectedness between local leaders and heads of health facilities were identified as enablers of health service utilization. Geographical factors, in particular location close to borders with mobile populations and migrants, and large populations with sparsely distributed health infrastructure, exacerbated by hilly topography and muddy roads were identified as barriers. Shortages of skilled health providers at the level of district hospitals were cited as contributing to poor maternal health outcomes. Conclusion: There is a need to take into account disparities between districts when allocating staff and financial resources in order to achieve universal coverage for high-quality maternal health services and better outcomes. Local innovations such as the use of SMS and WhatsApp text messages by health workers and financial protection schemes for poor patients improve solidarity and are worth to be scaled up. [ABSTRACT FROM AUTHOR]

Objectives. To determine whether the 2014 Affordable Care Act Medicaid expansion affected well-being in the low-income and general adult US populations. Methods. We obtained data from adults aged 18 to 64 years in the nationally representative Gallup-Sharecare Well-Being Index from 2010 to 2016 (n = 1 674 953). We used a difference-in-differences analysis to compare access to and difficulty affording health care and subjective well-being outcomes (happiness, sadness, worry, stress, and life satisfaction) before and after Medicaid expansion in states that did and did not expand Medicaid. Results. Access to health care increased, and difficulty affording health care declined following the Medicaid expansion. Medicaid expansion was not associated with changes to emotional states or life satisfaction over the study period in either the low-income population who newly gained health insurance or in the general adult population as a spillover effect of the policy change. Conclusions. Although the public health benefits of the Medicaid expansion are increasingly apparent, improved population well-being does not appear to be among them. Public Health Implications. Subjective well-being indicators may not be informative enough to evaluate the public health impact of expanded health insurance. [ABSTRACT FROM AUTHOR]

Objectives. To investigate use of electronic nicotine delivery systems (ENDS) among priority populations. Methods. Using 2016 through 2017 US nationally representative surveys (n = 11 688), we examined ENDS use by sociodemographic variables (age, education, poverty status, insurance, employment, race/ethnicity, sexual orientation) and combustible tobacco use. Results. Among individuals who currently use noncigarette combustible tobacco, those from certain backgrounds (young adults, those living below the poverty level, those less educated, sexual minorities, Blacks, Hispanics, and those without health insurance) were more likely to use ENDS. Among current cigarette smokers, those who were younger, living at or above poverty (ever use), with higher education (current use), sexual minority, and non-Black were more likely to use ENDS. Conclusions. Associations between sociodemographic variables and ENDS use varied depending on combustible tobacco use status, highlighting the need to consider multiple types of tobacco products to understand ENDS use among priority populations. The impact on tobacco disparities will ultimately depend on whether ENDS are used to transition completely away from combustible tobacco products and how this may differ across priority populations who use diverse tobacco products. [ABSTRACT FROM AUTHOR]

How much are low-income individuals willing to pay for health insurance, and what are the implications for insurance markets? Using administrative data from Massachusetts' subsidized insurance exchange, we exploit discontinuities in the subsidy schedule to estimate willingness to pay and costs of insurance among low-income adults. As subsidies decline, insurance take-up falls rapidly, dropping about 25 percent for each $40 increase in monthly enrollee premiums. Marginal enrollees tend to be lower-cost, indicating adverse selection into insurance. But across the entire distribution we can observe (approximately the bottom 70 percent of the willingness to pay distribution) enrollees' willingness to pay is always less than half of their own expected costs that they impose on the insurer. As a result, we estimate that take-up will be highly incomplete even with generous subsidies. If enrollee premiums were 25 percent of insurers' average costs, at most half of potential enrollees would buy insurance; even premiums subsidized to 10 percent of average costs would still leave at least 20 percent uninsured. We briefly consider potential explanations for these findings and their normative implications. (JEL G22, H51, H75, I13, I18) [ABSTRACT FROM AUTHOR]

Medicaid expansions through the Affordable Care Act began in January 2014, but we have little information about what is happening in rural areas where provider access and patient resources might be more limited. In 2008, Oregon held a lottery for restricted access to its Medicaid program for uninsured low-income adults not otherwise eligible for public coverage. The Oregon Health Insurance Experiment used this opportunity to conduct the first randomized controlled study of a public insurance expansion. This analysis builds off of previous work by comparing rural and urban survey outcomes and adds qualitative interviews with 86 rural study participants for context. We examine health care access and use, personal finances, and self-reported health. While urban and rural populations have unique demographic profiles, rural populations appear to have benefited from Medicaid as much as urban. Qualitative interviews revealed the distinctive challenges still facing low-income uninsured and newly insured rural populations. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Chronic obstructive pulmonary disease (COPD) is common but often underdiagnosed in the United States (US). Public health insurance coverage expansion may increase the prevalence of diagnosed COPD due to improved access to care and diagnosis. Objective: We sought to determine the effects of Medicaid expansion on the prevalence of diagnosed COPD among low‐income US adults. Methods: The 2011‐2015 Behavioral Risk Factor Surveillance System survey data were used to identify adults with annual household income <$50 000. The outcome was self‐report of being diagnosed with COPD by a health‐care provider. Difference‐in‐difference logistic regression contrasted the influence of period (pre‐expansion, 2011‐2013, vs post‐expansion, 2014‐2015) between states participating and opting out of Medicaid expansion. Results: Data on 521 622 respondents were analysed. The prevalence of diagnosed COPD was 7% in Medicaid expansion states and 8% in non‐participating states. In participating states, lack of health insurance among low‐income adults decreased from 32% to 21% after Medicaid expansion (P < .001), but the prevalence of diagnosed COPD was unchanged. Multivariable logistic regression confirmed that residents of participating states surveyed after Medicaid expansion were no more likely to report diagnosed COPD than residents of these states surveyed before Medicaid expansion (OR = 1.03; 95% CI: 0.97, 1.10; P = .276). Conclusions: Notwithstanding increased health insurance coverage among low‐income adults after Medicaid expansion, this policy did not increase the prevalence of diagnosed COPD. Access to primary care among new Medicaid enrollees and practices of diagnosing COPD in this setting should be evaluated to reduce the extent of undiagnosed COPD in socioeconomically disadvantaged groups. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate rates of member compliance with Iowa’s Medicaid expansion premium disincentive program. Methods. We used 2014 to 2015 Iowa Medicaid data to construct rolling 12-month cohorts of Wellness Plan and Marketplace Choice members (Iowa’s 2 Medicaid expansion waiver programs for individuals £ 100% and 101%–138% of the federal poverty level, respectively), calculated completion rates for required activities (i.e., wellness examinations and health risk assessments), and identified factors associated with program compliance. Results. Overall, 18.5% of Wellness Plan and 12.5% of Marketplace Choice members completed both activities (P< .001). From 2014 to 2015, completion rates for both activities decreased for Wellness Plan members but increased for Marketplace Choice members. Members who were younger, male, or non-White were less likely to complete required activities. Conclusions. Approximately 81% of Wellness Plan members and 87% of Marketplace Choice members failed to comply with program requirements and should have been subject to paying premiums the following year or face disenrollment. Disparities in completion rates may exacerbate disparities in insurance coverage and health outcomes. [ABSTRACT FROM AUTHOR]

The Affordable Care Act expanded health insurance for low- income, uninsured individuals. Few longitudinal analyses have investigated how insurance expansion influences cost and utilization among adults with chronic conditions. This study conducted longitudinal analysis investigating time trends in utilization and cost among newly insured, chronically ill, low- income individuals using Generalized Estimating Equations models. For hospitalization, hospital outpatient services, emergency department (ED) visits, and primary care visits, two indicators were measured: the proportion of enrollees with services and the average number of visits among users. The average health expenditure per person was estimated using a gamma distribution. Results indicate that the number of individuals using inpatient or ED services was highest during the first six months following insurance coverage and decreased in subsequent periods, while primary care visits increased during the first year. Using six- month rather than annual measures of utilization and cost may be necessary to identify short- run changes following initial insurance coverage. [ABSTRACT FROM AUTHOR]

Background: States routinely may consider rollbacks of Medicaid expansions to address statewide economic conditions. To the authors' knowledge, little is known regarding the effects of public insurance contractions on health outcomes. The current study examined the effects of the 2005 Medicaid disenrollment in Tennessee on breast cancer stage at the time of diagnosis and delays in treatment among nonelderly women.Methods: The authors used Tennessee Cancer Registry data from 2002 through 2008 and estimated a difference-in-difference model comparing women diagnosed with breast cancer who lived in low-income zip codes (and therefore were more likely to be subject to disenrollment) with a similar group of women who lived in high-income zip codes before and after the 2005 Medicaid disenrollment. The study outcomes were changes in stage of disease at the time of diagnosis and delays in treatment of >60 days and >90 days.Results: Overall, nonelderly women in Tennessee were diagnosed at later stages of disease and experienced more delays in treatment in the period after disenrollment. Disenrollment was found to be associated with a 3.3-percentage point increase in late stage of disease at the time of diagnosis (P = .024), a 1.9-percentage point decrease in having a delay of >60 days in surgery (P = .024), and a 1.4-percentage point decrease in having a delay of >90 days in treatment (P = .054) for women living in low-income zip codes compared with women residing in high-income zip codes.Conclusions: The results of the current study indicate that Medicaid disenrollment is associated with a later stage of disease at the time of breast cancer diagnosis, thereby providing evidence of the potential negative health impacts of Medicaid contractions. Cancer 2017;123:3312-9. © 2017 American Cancer Society. [ABSTRACT FROM AUTHOR]

Objective The goal of this study was to assess the likelihood of purchasing antidepressants, number of antidepressants purchased, and out-of-pocket ( OOP) and total spending on antidepressants among people living with serious psychological distress ( SPD) from 2008 to 2014. Methods Data source: Medical Expenditure Panel Survey (MEPS) Data for the years from 2008 to 2014. Sample Design: A retrospective cross-sectional design was employed. MEPS is a nationally representative survey of the civilian, noninstitutionalised population in the U.S. The subset of individuals with serious psychological distress ( SPD) who used any antidepressant in the study period was 2401. Measurements: The study uses an established cut-off for serious psychological distress of a Kessler-6 score of ≥13. The Anderson Health Behavior model is used to select covariates. Data analysis: We calculated the mean number of scripts purchased, odds of any purchase, OOP, third-party and total payments for prescription antidepressants among people with SPD using Stata 14. Key findings The number of scripts purchased per person remained relatively stable between 2008 and 14. The odds of purchasing scripts were higher for Caucasian women, and were significantly lower for African Americans and people who spoke a language other than English at home. There was a significant decline in OOP among near poor, low-income and low-educational attainment people in 2014. Conclusions Evidence suggests that low-income, low-educational attainment people with SPD benefitted from health reform initiatives in the form of lower OOP in 2014. Maintenance of policies that enable insurance coverage of these people may have a role in ensuring access to needed antidepressants. [ABSTRACT FROM AUTHOR]

In order to provide healthcare to low-income people, especially those living in rural areas, the Thai government introduced its Universal Coverage Scheme (UCS) in 2001–2002, becoming one of the first low- and middle-income countries to do so. We employ a difference-in-difference-in-difference (DDD) approach to examine whether UCS effectively reduces out-of-pocket healthcare expenditure across income levels and regions. The empirical results note a significant reduction in medical expenditure for the post-UCS period in outpatient as well as inpatient expenditures. The impact of UCS on the difference in medical expenditure between the treated and control groups varies across regions, while there is no significant difference across income level groups. Thus, by helping to pay an affordable copayment for ambulatory care, UCS has overall softened the high medical costs and provides accessible medical resources for poor regions and middle-income people. [ABSTRACT FROM PUBLISHER]

With the push to repeal the Affordable Care Act (ACA) and replace it with the American Health Care Act (AHCA), there is renewed interest in using tax credits to increase health insurance coverage. A similar tax creditdriven policy, the Health Insurance Tax Credit (HITC), was implemented from 1991 to 1993. To date, only one paper (Cebi & Woodbury, 2014) has analyzed the effectiveness of the HITC in increasing health insurance coverage. This paper re-examines the efficacy of the HITC by using a different data set from the Survey of Income and Program Participation (SIPP). This examination yields similar results to those in Cebi & Woodbury (2014), which is that the HITC increased health insurance coverage among single mothers by about 6.6 percentage points. Further, this study finds that the HITC appeared to influence the rates of usage of health care services. This paper concludes by discussing the implications of these findings for the broader debate surrounding health care reform in the present moment. [ABSTRACT FROM AUTHOR]

The article discusses health reform and the status of health care safety net health care providers in the wake of the enactment of the U.S. Patient Protection and Affordable Care Act (ACA), and it mentions health care services for low-income, uninsured, and immigrants in America. Health insurance coverage gaps in the U.S. are addressed, along with community health centers, safety net hospitals, Medicaid insurance, and access to quality health care in America.