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Objectives Among childbearing women, insurance coverage determines degree of access to preventive and emergency care for maternal and infant health. Maternal-infant dyads with dual burden of severe maternal morbidity and preterm birth experience high physical and psychological morbidity, and the risk of dual burden varies by insurance type. We examined whether sociodemographic and perinatal risk factors of dual burden differed by insurance type. Methods We estimated relative risks of dual burden by maternal sociodemographic and perinatal characteristics in the 2007-2012 California birth cohort dataset stratified by insurance type and compared effects across insurance types using Wald Z-statistics. Results Dual burden ranged from 0.36% of privately insured births to 0.41% of uninsured births. Obstetric comorbidities, multiple gestation, parity, and birth mode conferred the largest risks across all insurance types, but effect magnitude differed. The adjusted relative risk of dual burden associated with preeclampsia superimposed on preexisting hypertension ranged from 9.1 (95% CI 7.6-10.9) for privately insured to 15.9 (95% CI 9.1-27.6) among uninsured. The adjusted relative risk of dual burden associated with cesarean birth ranged from 3.1 (95% CI 2.7-3.5) for women with Medi-Cal to 5.4 (95% CI 3.5-8.2) for women with other insurance among primiparas, and 7.0 (95% CI 6.0-8.3) to 19.4 (95% CI 10.3-36.3), respectively, among multiparas. Conclusions Risk factors of dual burden differed by insurance type across sociodemographic and perinatal factors, suggesting that care quality may differ by insurance type. Attention to peripartum care access and care quality provided by insurance type is needed to improve maternal and neonatal health., Author(s): Alison M. El Ayadi [sup.1] [sup.8] , Rebecca J. Baer [sup.2] [sup.4] , Caryl Gay [sup.3] [sup.4] , Henry C. Lee [sup.5] [sup.6] , Juno Obedin-Maliver [sup.7] , Laura [...]

Objective To measure the association between dental and medical insurance with the receipt of dental cleaning during pregnancy. Methods We analyzed Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2012 to 2015 on 145,051 women with a recent live birth from 36 states. We used adjusted prevalence ratios [aPR] from multivariable regression to examine the association of dental and medical insurance with receipt of dental cleaning during pregnancy, controlling for selected covariates that influence dental care utilization. Results Seventy-seven percent (77%) of all women reported having dental insurance during pregnancy. Receipt of dental cleaning before pregnancy was strongly associated with dental cleaning during pregnancy. Among women without pre-pregnancy dental cleaning who had dental insurance, those with Medicaid medical insurance had a significantly higher prevalence of dental cleaning during pregnancy [aPR = 1.42, 95% CI (1.32 - 1.52)], compared to those private medical insurance. Among women without pre-pregnancy dental cleaning, those without dental insurance but with Medicaid medical insurance were about 70% less likely to have dental cleaning during pregnancy compared to those with dental and private medical insurance. Conclusions for Practice With or without dental insurance, pre-pregnancy dental cleaning was strongly associated with dental cleaning during pregnancy. Dental insurance was an important determinant of dental utilization. Medical insurance had an independent and positive effect. This effect varied by private versus Medicaid medical insurance. Programs which provide women with dental insurance both before and during pregnancy could improve the oral health of maternal and infant populations., Author(s): Valerie Robison [sup.1] , Brenda Bauman [sup.2] , Denise V. D'Angelo [sup.2] , Lorena Espinoza [sup.1] , Gina Thornton-Evans [sup.1] , Mei Lin [sup.1] Author Affiliations: (1) grid.416738.f, 0000 [...]

Objective To measure the association of preconception health insurance status with preconception health among women in New York City, and examine whether this association is modified by race/ethnicity. Methods Using data from the New York City Pregnancy Risk Assessment Monitoring System 2009-2011 (n = 3929), we created a 'Preconception Health Score' (PHS) capturing modifiable behaviors, healthcare services utilization, pregnancy intention, and timely entry into prenatal care. We then built multivariable logistic regression models to measure the association of PHS with health insurance status and race/ethnicity. Results We found PHS to be higher among women with private insurance (7.3 ± 0.07) or public insurance (6.3 ± 0.08) before pregnancy than no insurance (5.9 ± 0.09) (p < .001). However, when stratified by race/ethnicity, the positive association of PHS with insurance was absent in the non-white population. Conclusions for Practice Having health insurance during the pre-pregnancy period is associated with greater health among white women, but not among black or Hispanic women in NYC., Author(s): Rebecca Mahn Hawks [sup.1] , Aileen P. McGinn [sup.2] , Peter S. Bernstein [sup.3] , Jonathan N. Tobin [sup.2] [sup.4] Author Affiliations: (Aff1) 0000 0001 2109 4251, grid.240324.3, Department [...]

The availability of health insurance is a crucial factor in the retirement decision. Women are substantially less likely to have health insurance from their own employment. Using the Health and [...]

Objectives. We examined racial/ethnic disparities in highly active antiretroviral therapy (HAART) use and whether differences are moderated by substance use or insurance status, using data from the Women's Interagency HIV Study (WIHS). Methods. Logistic regression examined HAART use in a longitudinal cohort of women for whom HAART was clinically indicated in 2005 (N=1354). Results. Approximately 3 of every 10 eligible women reported not taking HAART. African American and Hispanic women were less likely than were White women to use HAART. After we adjusted for potential confounders, the higher likelihood of not using HAART persisted for African American but not for Hispanic women. Uninsured and privately insured women, regardless of race/ ethnicity, were less likely than were Medicaid enrollees to use HAART. Although alcohol use was related to HAART nonuse, illicit drug use was not. Conclusions. These findings suggest that expanding and improving insurance coverage should increase access to antiretroviral therapy across racial/ethnic groups, but it is not likely to eliminate the disparity in use of HAART between African American and White women with HIV/AIDS. (Am J Public Health. 2010; 100:1493-1499. doi: 10.2105/AJPH.2008.158949)

Objectives. The aim of this study was to describe and contrast perceptions of self-management among socioeconomically vulnerable and nonvulnerable older adults. Methods. We used in-depth, in-home interviews guided by identity theory. Analyses included reviewing audiotapes, creating and comparing field notes, coding transcripts, and identifying themes based on case summaries. Interviews took place in patients' homes. Participants were 23 vulnerable older adults with incomes at or below 200% of the federal poverty level and no private insurance and 12 older adults with private health insurance. Results. The vulnerable sample had lower educational attainment and lower health literacy than the privately insured sample. Keeping doctor visits and taking prescription medications largely defined self-management for the vulnerable sample but were just two of a number of roles noted by the privately insured group, who expressed health promotion as the key to healthy aging. The vulnerable interviewees relayed few examples of healthy aging and did not have expectations for healthful aging. In contrast, the privately insured interviewees gave examples and had expectations of living long and healthfully into old age. Discussion. Improved understanding of the role of social context in expectations regarding aging, and awareness of and priorities for self-management, could lead to improvements in self-management support and thus chronic care outcomes. Key Words: Self-management--Health literacy--Qualitative research--Health disparities.

Introduction of new drugs that would replace the old ones was found to decrease medical spending. Decreasing the age of drugs used after approval results in increased drug spending and in reduced non-drug spending, even in Medicare members. The impacts of medical insurance coverage on purchasing of prescription drugs, are investigated.

Impact of uninsured hospital expenses on consumers' complete annuitization of private savings is presented.

The use of a difference-in-difference approach reveals that mandated insurance coverage of infertility treatment by 15 U.S. states increased first birth rates for women over age 35 by 32 percent.

In this study, we examine the effects of Medicaid managed care (MMC) on prenatal care utilization, infant birth weight, pre-term birth, and use of cesarean section in the United States. We obtain separate estimates of the effect of primary care case management managed care programs and health maintenance organization managed care plans on these outcomes. The results suggest the following: among white, non-Hispanic women, MMC was associated with a 2 percent decrease in the number of prenatal care visits and a 3-5 percent increase the incidence of inadequate prenatal care; MMC was associated with a significant increase in the incidence pre-term birth for non-Hispanic white women but that this association does not appear to be causal; and MMC had no association with the incidence of cesarean section. Keywords: Health insurance: Infant health: Social policy

The effect of reform on the likelihood, that workers are offered insurance, have employment based coverage, or are policy holders of an employment based plan is discussed. Differences-in differences (DD) and differences-in-differences-indifferences (DDD), are used to evaluate the differential effects of alternative reform measures, on high and low risk workers.

The differences between breast cancer survivors and a non-cancer control group in terms of employment, hours worked, wages, and earnings are shown according to the data from the Health and Retirement study (HRS). The research pointing to heterogeneous labor market responses to breast cancer shows that breast cancer does not appear to be debilitating for women who remain in the work force.

This paper examines the impact of employer-provided health insurance on the job mobility of males. The study finds that married males do not stay at their job for fear of loosing health insurance, however, health insurance benefits are likely to reduce the mobility of unmarried males by an estimated 10-15 percent.

The U.S. economy is in turmoil, real estate values are generally down, the stock market has not fully recovered, and T-bill returns are miserly. Investors are looking for alternative, advantageous [...]