-
Public Health Reports (Washington, D.C.... 1991
Topics: Delivery of Health Care; Female; Humans; Infant; Infant Mortality; Infant, Newborn; Medical Indigency; Sexually Transmitted Diseases; United States; United States Public Health Service
PubMed: 1910179
DOI: No ID Found -
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 -
The Journal of the Royal College of... Aug 1986Hospital admissions from a general practice were studied for one year. One-third of all admissions were found to be to a community hospital. Those admitted were mainly...
Hospital admissions from a general practice were studied for one year. One-third of all admissions were found to be to a community hospital. Those admitted were mainly elderly people. The majority of patients stayed in the community hospital only a short time and 69% of patients returned home on discharge. Social, nursing and medical factors determined admission and discharge. Social factors were found to be increasingly important as the age of patients increases while medical factors become less important.
Topics: Adolescent; Adult; Age Factors; Aged; Child; Child, Preschool; England; Female; Hospitals, Community; Humans; Infant; Male; Medical Indigency; Middle Aged; Patient Admission
PubMed: 3735225
DOI: No ID Found -
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 -
Public Health Reports (Washington, D.C.... 1991
Topics: Health Services Needs and Demand; Medical Indigency; National Health Programs; United States; United States Health Resources and Services Administration
PubMed: 1899931
DOI: No ID Found -
Health Services Research Feb 1990While estimates of the country's uninsured vary, ranging from 10 to 18 percent of the general population, virtually every study on use of medical services reports that...
While estimates of the country's uninsured vary, ranging from 10 to 18 percent of the general population, virtually every study on use of medical services reports that lack of health insurance represents a major barrier to medical care. Based on the 1986 national Robert Wood Johnson Access Survey of 10,130 noninstitutionalized persons, the characteristics of working-age adults without health insurance, and the consequences, are examined. Among working-age adults, the uninsured are most likely to be poor or near-poor, Hispanic, young, unmarried and unemployed. Compared with the insured, they have significantly fewer ambulatory visits during a year, are less likely to have contact with a medical provider during a 12-month period, and are more likely to receive their care in a hospital outpatient clinic or emergency room. Differences in health status do not account for these findings. Especially among persons with chronic and serious illnesses, the uninsured are less likely than the insured to receive medical care. Further, the uninsured are significantly more likely to report needing but not receiving medical care, primarily for economic reasons, and although poorer, they have higher out-of-pocket medical expenses than others in the population.
Topics: Adult; Age Factors; Ambulatory Care; Female; Health Services Accessibility; Health Status; Hispanic or Latino; Humans; Income; Interviews as Topic; Male; Marriage; Medical Indigency; Middle Aged; Unemployment; United States
PubMed: 2312309
DOI: No ID Found -
BMC Health Services Research Mar 2007More than 72% of health expenditure in India is financed by individual households at the time of illness through out-of-pocket payments. This is a highly regressive way... (Comparative Study)
Comparative Study
BACKGROUND
More than 72% of health expenditure in India is financed by individual households at the time of illness through out-of-pocket payments. This is a highly regressive way of financing health care and sometimes leads to impoverishment. Health insurance is recommended as a measure to protect households from such catastrophic health expenditure (CHE). We studied two Indian community health insurance (CHI) schemes, ACCORD and SEWA, to determine whether insured households are protected from CHE.
METHODS
ACCORD provides health insurance cover for the indigenous population, living in Gudalur, Tamil Nadu. SEWA provides insurance cover for self employed women in the state of Gujarat. Both cover hospitalisation expenses, but only upto a maximum limit of US$23 and US$45, respectively. We reviewed the insurance claims registers in both schemes and identified patients who were hospitalised during the period 01/04/2003 to 31/03/2004. Details of their diagnoses, places and costs of treatment and self-reported annual incomes were obtained. There is no single definition of CHE and none of these have been validated. For this research, we used the following definition; "annual hospital expenditure greater than 10% of annual income," to identify those who experienced CHE.
RESULTS
There were a total of 683 and 3152 hospital admissions at ACCORD and SEWA, respectively. In the absence of the CHI scheme, all of the patients at ACCORD and SEWA would have had to pay OOP for their hospitalisation. With the CHI scheme, 67% and 34% of patients did not have to make any out-of-pocket (OOP) payment for their hospital expenses at ACCORD and SEWA, respectively. Both CHI schemes halved the number of households that would have experienced CHE by covering hospital costs. However, despite this, 4% and 23% of households with admissions still experienced CHE at ACCORD and SEWA, respectively. This was related to the following conditions: low annual income, benefit packages with low maximum limits, exclusion of some conditions from the benefit package, and use of the private sector for admissions.
CONCLUSION
CHI appears to be effective at halving the incidence of CHE among hospitalised patients. This protection could be further enhanced by improving the design of the CHI schemes, especially by increasing the upper limits of benefit packages, minimising exclusions and controlling costs.
Topics: Adult; Catastrophic Illness; Female; Financing, Personal; Health Expenditures; Health Policy; Health Services, Indigenous; Hospitalization; Humans; India; Insurance Claim Review; Insurance, Major Medical; Male; Medical Indigency; Patient Admission; Program Evaluation; Registries; Women, Working
PubMed: 17362506
DOI: 10.1186/1472-6963-7-43 -
Henry Ford Hospital Medical Journal 1990
Topics: Contract Services; Humans; Interinstitutional Relations; Managed Care Programs; Medical Indigency; Michigan; Urban Population
PubMed: 2279943
DOI: No ID Found -
PLoS Medicine Oct 2007The editors discuss a special collection of articles in that aims to highlight the profound influence of poverty upon health.
The editors discuss a special collection of articles in that aims to highlight the profound influence of poverty upon health.
Topics: Global Health; Health Promotion; Health Status; Healthcare Disparities; Humans; International Cooperation; Medical Indigency; Poverty; Publishing
PubMed: 17958468
DOI: 10.1371/journal.pmed.0040310 -
Pain Medicine (Malden, Mass.) Jan 2014We tested the hypothesis that prescription coverage affects the prescribing of long-acting opiates to indigent inner city minority patients with cancer pain.
PURPOSE
We tested the hypothesis that prescription coverage affects the prescribing of long-acting opiates to indigent inner city minority patients with cancer pain.
MATERIALS AND METHODS
We conducted a chart review of 360 patients treated in the Oncology Practice at University of Medicine and Dentistry of New Jersey University Hospital, who were prescribed opiate pain medications. Half the patients were charity care or self-pay (CC/SP), without the benefit of prescription coverage, and half had Medicaid, with unlimited prescription coverage. We evaluated patients discharged from a hospitalization, who had three subsequent outpatient follow-up visits. We compared demographics, pain intensity, the type and dose of opiates, adherence to prescribed pain regimen, unscheduled emergency department visits, and unscheduled hospitalizations.
RESULTS
There was a significantly greater use of long-acting opiates in the Medicaid group than in the CC/SP group. The Medicaid group had significantly more African American patients and a greater rate of smoking and substance use, and the CC/SP group disproportionately more Hispanic and Asian patients and less smoking and substance use. Hispanic and Asian patients were less likely to have long-acting opiates prescribed to them. Pain levels and adherence were equivalent in both groups and were not affected by any of these variables except stage of disease, which was equally distributed in the two groups.
CONCLUSION
Appropriate use of long-acting opiates for equivalent levels of cancer pain was influenced only by the availability of prescription coverage. The group without prescription coverage and receiving fewer long-acting opiates had disproportionately more Hispanic and Asian patients.
Topics: Adult; Alcoholism; Chronic Pain; Delayed-Action Preparations; Drug Utilization; Ethnicity; Female; Hospitals, University; Humans; Insurance, Pharmaceutical Services; Male; Medicaid; Medical Indigency; Medication Adherence; Middle Aged; Minority Groups; Narcotics; Neoplasms; New Jersey; Pain Management; Pain Measurement; Practice Patterns, Physicians'; Retrospective Studies; Smoking; Substance-Related Disorders; United States; Urban Population
PubMed: 24106748
DOI: 10.1111/pme.12238