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Journal of the National Medical... Apr 2004The United States spends more than the rest of the world on healthcare. In 2000, the U.S. health bill was 1.3 trillion dollars, 14.5% of its gross domestic product. Yet,... (Comparative Study)
Comparative Study
The United States spends more than the rest of the world on healthcare. In 2000, the U.S. health bill was 1.3 trillion dollars, 14.5% of its gross domestic product. Yet, according to the WHO World Health Report 2000, the United States ranked 37th of 191 member nations in overall health system performance. Racial/ethnic disparities in health outcomes are the most obvious examples of an unbalanced healthcare system. This presentation will examine health disparities in the United States and reveal how health disparities among and within countries affect the health and well-being of the African Diaspora.
Topics: Black or African American; Black People; Global Health; Health Policy; Health Services Accessibility; Humans; Medical Indigency; National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; Social Justice; Socioeconomic Factors; Sociology, Medical; United States
PubMed: 15101675
DOI: No ID Found -
Health Services Research Feb 1989Current knowledge on health care for the rural poor and uninsured demonstrates little descriptive and empirical knowledge on this population. Policy strategies call for... (Review)
Review
Current knowledge on health care for the rural poor and uninsured demonstrates little descriptive and empirical knowledge on this population. Policy strategies call for a better understanding of the gaps in insurance coverage and the special problems of rural residents, especially those with low incomes.
Topics: Adolescent; Adult; Child; Hospitalization; Humans; Insurance, Health; Medicaid; Medical Indigency; Middle Aged; Poverty; Rural Health; Rural Population; United States
PubMed: 2645253
DOI: No ID Found -
PLoS Medicine Oct 2007The authors present a framework for analysis and action to explore and improve access to health care in resource-poor countries, especially in Africa. (Review)
Review
The authors present a framework for analysis and action to explore and improve access to health care in resource-poor countries, especially in Africa.
Topics: Adult; Antimalarials; Child; Foundations; Health Promotion; Health Services Accessibility; Healthcare Disparities; Humans; International Cooperation; Malaria; Medical Indigency; Models, Theoretical; National Health Programs; Patient Acceptance of Health Care; Poverty; Quality of Health Care; Rural Health; Tanzania; Unemployment
PubMed: 17958467
DOI: 10.1371/journal.pmed.0040308 -
The Laryngoscope Sep 2013This study was designed to describe the implementation, utilization, and outcomes of an otolaryngology clinic for indigent patients employing a novel design. (Comparative Study)
Comparative Study
OBJECTIVES/HYPOTHESIS
This study was designed to describe the implementation, utilization, and outcomes of an otolaryngology clinic for indigent patients employing a novel design.
STUDY DESIGN
Pilot study.
METHODS
A tertiary-care academic otolaryngology department partnered with a nonprofit outpatient clinic for indigent patients in order to provide free subspecialty consultation services. A novel format was utilized in which the department provided on-site, scheduled outpatient multidisciplinary consultation on weekends, staffed by volunteer health care providers and ancillary staff. A review of the program was conducted using prospectively collected data. Clinic design, staffing, utilization, and feasibility were described, along with demographic and clinical data for all patients participating in the clinic from October 2010 through January 2012.
RESULTS
Five clinics were held over 15 months, totaling 74 patient visits, with positive feedback regarding accessibility and quality of services provided. A total of 60 procedures were performed, including audiograms, endoscopies, otologic procedures, biopsies and/or excisions. The estimated value of medical services that were provided was $37,302. Four potentially life-threatening conditions were newly diagnosed. Twenty patients received conclusive evaluation and treatment at the time of their first visit. Eighteen patients required further subspecialty treatment and/or surgery that could not be provided in the outpatient setting, and were referred appropriately.
CONCLUSIONS
The partnership between an academic otolaryngology department and a nonprofit clinic provided free on-site consultation for indigent patients. Such an arrangement is feasible, well utilized, and successful in delivering comprehensive specialized services to indigent patients who lack traditional access to medical care.
Topics: Academic Medical Centers; Adolescent; Adult; Aged; Ambulatory Care Facilities; Feasibility Studies; Female; Health Plan Implementation; Health Services Accessibility; Humans; Male; Medical Indigency; Michigan; Middle Aged; Organizations, Nonprofit; Otolaryngology; Otorhinolaryngologic Diseases; Pilot Projects; Poverty; Program Development; Program Evaluation; Risk Assessment; Treatment Outcome; Young Adult
PubMed: 23842787
DOI: 10.1002/lary.23880 -
The Israel Medical Association Journal... Oct 2001Following the recent drought in Ethiopia, the Jewish Agency, aided by the Israel Ministry of Foreign Affairs, launched a medical relief mission to a rural district in...
BACKGROUND
Following the recent drought in Ethiopia, the Jewish Agency, aided by the Israel Ministry of Foreign Affairs, launched a medical relief mission to a rural district in Ethiopia in May-August 2000.
OBJECTIVES
To present the current medical needs and deficiencies in this representative region of Central Africa, to describe the mission's mode of operation, and to propose alternative operative modes.
METHODS
We critically evaluate the current local needs and existing medical system, retrospectively analyze the mission's work and the patients' characteristics, and summarize a panel discussion of all participants and organizers regarding potential alternative operative modes.
RESULTS
An ongoing medical disaster exists in Ethiopia, resulting from the burden of morbidity, an inadequate health budget, and insufficient medical personnel, facilities and supplies. The mission operated a mobile outreach clinic for 3 months, providing primary care to 2,500 patients at an estimated cost of $48 per patient. Frequent clinical diagnoses included gastrointestinal and respiratory tract infections, skin and ocular diseases (particularly trachoma), sexually transmitted diseases, AIDS, tuberculosis, intestinal parasitosis, malnutrition and malaria.
CONCLUSIONS
This type of operation is feasible but its overall impact is marginal and temporary. Potential alternative models of providing medical support under such circumstances are outlined.
Topics: Adolescent; Adult; Age Distribution; Child; Child, Preschool; Communicable Diseases; Disasters; Ethiopia; Female; Health Education; Humans; Infant; Male; Medical Indigency; Middle Aged; Mobile Health Units; Relief Work; Rural Population
PubMed: 11692556
DOI: No ID Found -
PloS One 2020In the global context, health and the quality of life of people are adversely affected by either one or more types of chronic diseases. This paper investigates the...
In the global context, health and the quality of life of people are adversely affected by either one or more types of chronic diseases. This paper investigates the differences in the level of income and expenditure between chronically-ill people and non-chronic population. Data were gathered from a national level survey conducted namely, the Household Income and Expenditure Survey (HIES) by the Department of Census and Statistics (DCS) of Sri Lanka. These data were statistically analysed with one-way and two-way ANOVA, to identify the factors that cause the differences among different groups. For the first time, this study makes an attempt using survey data, to examine the differences in the level of income and expenditure among chronically-ill people in Sri Lanka. Accordingly, the study discovered that married females who do not engage in any type of economic activity (being unemployed due to the disability associated with the respective chronic illness), in the age category of 40-65, having an educational level of tertiary education or below and living in the urban sector have a higher likelihood of suffering from chronic diseases. If workforce population is compelled to lose jobs, it can lead to income insecurity and impair their quality of lives. Under above findings, it is reasonable to assume that most health care expenses are out of pocket. Furthermore, the study infers that chronic illnesses have a statistically proven significant differences towards the income and expenditure level. This has caused due to the interaction of demographic and socio-economic characteristics associated with chronic illnesses. Considering private-public sector partnerships that enable affordable access to health care services for all as well as implementation of commercial insurance and community-based mutual services that help ease burden to the public, are vital when formulating effective policies and strategies related to the healthcare sector. Sri Lanka is making strong efforts to support its healthcare sector and public, which was affected by the coronavirus (COVID-19) in early 2020. Therefore, findings of this paper will be useful to gain insights on the differences of chronic illnesses towards the income and expenditure of chronically-ill patients in Sri Lanka.
Topics: Adolescent; Adult; Aged; Analysis of Variance; Betacoronavirus; COVID-19; Child; Child, Preschool; Chronic Disease; Comorbidity; Coronavirus Infections; Developing Countries; Disabled Persons; Ethnicity; Family Characteristics; Female; Food; Health Expenditures; Humans; Income; Infant; Infant, Newborn; Male; Medical Indigency; Middle Aged; Pandemics; Pneumonia, Viral; Poverty; SARS-CoV-2; Socioeconomic Factors; Sri Lanka; Surveys and Questionnaires; Young Adult
PubMed: 33113548
DOI: 10.1371/journal.pone.0239576 -
Clinical Journal of the American... May 2010In the United States, relatively little is known about clinical outcomes of chronic kidney disease (CKD) in vulnerable populations utilizing public health systems. The...
BACKGROUND AND OBJECTIVES
In the United States, relatively little is known about clinical outcomes of chronic kidney disease (CKD) in vulnerable populations utilizing public health systems. The primary study objectives were to describe patient characteristics, incident ESRD, and mortality in adults with nondialysis-dependent CKD receiving care in the health care safety net.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
Time to ESRD and time to death were examined among a cohort of 15,353 ambulatory adults with nondialysis-dependent CKD from the Community Health Network of San Francisco.
RESULTS
The mean age of the CKD cohort was 59.0 +/- 13.8 years; 50% of the cohort was younger than 60 years and 26% was younger than 50 years. Most (72%) were members of nonwhite racial-ethnic groups, 73% were indigent (annual income <$15,000) and 18% were uninsured. In adjusted analyses, blacks [hazard ratio (95% confidence interval), 4.00 (2.99 to 5.35)], Hispanics [2.20 (1.46 to 3.30)], and Asians/Pacific Islanders [3.84 (2.73 to 5.40)] had higher risks of progression to ESRD than non-Hispanic whites. The higher risk of progression to ESRD among nonwhite compared with white persons with CKD was not explained by lower relative mortality.
CONCLUSIONS
Adults with CKD stages 3 to 5 cared for within an urban public health system were relatively young and predominantly nonwhite-both factors associated with a higher risk of progression to ESRD. These findings call for targeted efforts to assess the burden and progression of CKD within other public and safety-net health systems in this country.
Topics: Adult; Aged; Ambulatory Care; Community Networks; Disease Progression; Ethnicity; Female; Humans; Incidence; Kidney Diseases; Kidney Failure, Chronic; Male; Medical Indigency; Medically Uninsured; Middle Aged; Poverty; Risk Assessment; Risk Factors; San Francisco; Time Factors; Treatment Outcome; Urban Health; Urban Health Services; Urban Population
PubMed: 20200149
DOI: 10.2215/CJN.09011209 -
Clinical Orthopaedics and Related... May 2012There is a perception that socioeconomically disadvantaged patients tend to sue their doctors more frequently. As a result, some physicians may be reluctant to treat...
BACKGROUND
There is a perception that socioeconomically disadvantaged patients tend to sue their doctors more frequently. As a result, some physicians may be reluctant to treat poor patients or treat such patients differently from other patient groups in terms of medical care provided.
QUESTIONS/PURPOSES
We (1) examined existing literature to refute the notion that poor patients are inclined to sue doctors more than other patients, (2) explored unconscious bias as an explanation as to why the perception of the poor being more litigious may exist despite evidence to the contrary, and (3) assessed the role of culturally competent awareness and knowledge in confronting physician bias.
METHODS
We reviewed medical and social literature to identify studies that have examined differences in litigation rates and related medical malpractice claims among socioeconomically disadvantaged patients versus other groups of patients.
RESULTS
Contrary to popular perception, existing studies show poor patients, in fact, tend to sue physicians less often. This may be related to a relative lack of access to legal resources and the nature of the contingency fee system in medical malpractice claims.
CONCLUSIONS
Misperceptions such as the one examined in this article that assume a relationship between patient poverty and medical malpractice litigation may arise from unconscious physician bias and other social variables. Cultural competency can be helpful in mitigating such bias, improving medical care, and addressing the risk of medical malpractice claims.
Topics: Cultural Competency; Humans; Legislation, Medical; Malpractice; Medical Errors; Medical Indigency; Medicine; Motivation; Patients; Physician-Patient Relations; Poverty; Prejudice
PubMed: 22367624
DOI: 10.1007/s11999-012-2254-2 -
Gaceta Sanitaria 1989
Topics: Community Health Services; Disease Susceptibility; Health Planning; Humans; Medical Indigency; Public Health; Unemployment
PubMed: 2507464
DOI: 10.1016/s0213-9111(89)70966-3 -
JAMA Apr 2008Cost-related medication nonadherence (CRN) has been a persistent problem for individuals who are elderly and disabled in the United States. The impact of Medicare...
CONTEXT
Cost-related medication nonadherence (CRN) has been a persistent problem for individuals who are elderly and disabled in the United States. The impact of Medicare prescription drug coverage (Part D) on CRN is unknown.
OBJECTIVE
To estimate changes in CRN and forgoing basic needs to pay for drugs following Part D implementation.
DESIGN, SETTING, AND PARTICIPANTS
In a population-level study design, changes in study outcomes between 2005 and 2006 before and after Medicare Part D implementation were compared with historical changes between 2004 and 2005. The community-dwelling sample of the nationally representative Medicare Current Beneficiary Survey (unweighted unique n = 24,234; response rate, 72.3%) was used, and logistic regression analyses were controlled for demographic characteristics, health status, and historical trends.
MAIN OUTCOME MEASURES
Self-reports of CRN (skipping or reducing doses, not obtaining prescriptions) and spending less on basic needs to afford medicines.
RESULTS
The unadjusted, weighted prevalence of CRN was 15.2% in 2004, 14.1% in 2005, and 11.5% after Part D implementation in 2006. The prevalence of spending less on basic needs was 10.6% in 2004, 11.1% in 2005, and 7.6% in 2006. Adjusted analyses comparing 2006 with 2005 and controlling for historical changes (2005 vs 2004) demonstrated significant decreases in the odds of CRN (ratio of odds ratios [ORs], 0.85; 95% confidence interval [CI], 0.74-0.98; P = .03) and spending less on basic needs (ratio of ORs, 0.59; 95% CI, 0.48-0.72; P < .001). No significant changes in CRN were observed among beneficiaries with fair to poor health (ratio of ORs, 1.00; 95% CI, 0.82-1.21; P = .97), despite high baseline CRN prevalence for this group (22.2% in 2005) and significant decreases among beneficiaries with good to excellent health (ratio of ORs, 0.77; 95% CI, 0.63-0.95; P = .02). However, significant reductions in spending less on basic needs were observed in both groups (fair to poor health: ratio of ORs, 0.60; 95% CI, 0.47-0.75; P < .001; and good to excellent health: ratio of ORs, 0.57; 95% CI, 0.44-0.75; P < .001).
CONCLUSIONS
In this survey population, there was evidence for a small but significant overall decrease in CRN and forgoing basic needs following Part D implementation. However, no net decrease in CRN after Part D was observed among the sickest beneficiaries, who continued to experience higher rates of CRN.
Topics: Aged; Aged, 80 and over; Drug Costs; Drug Utilization; Female; Financing, Personal; Health Surveys; Humans; Logistic Models; Male; Medical Indigency; Medicare Part D; Middle Aged; Socioeconomic Factors; Treatment Refusal; United States
PubMed: 18430911
DOI: 10.1001/jama.299.16.1922