United States-Mexico cross-border health insurance initiatives: Salud Migrante and Medicare in Mexico.

While U.S. health care reform will most likely reduce the overall number of uninsured Mexican-Americans, it does not address challenges related to health care coverage for undocumented Mexican immigrants, who will remain uninsured under the measures of the reform; documented low-income Mexican immigrants who have not met the five-year waiting period required for Medicaid benefits; or the growing number of retired U.S. citizens living in Mexico, who lack easy access to Medicare-supported services. This article reviews two promising binational initiatives that could help address these challenges-Salud Migrante and Medicare in Mexico; discusses their prospective applications within the context of U.S. health care reform; and identifies potential challenges to their implementation (legal, political, and regulatory), as well as the possible benefits, including coverage of uninsured Mexican immigrants, and their integration into the U.S. health care system (through Salud Migrante), and access to lower-cost Medicare-supported health care for U.S. retirees in Mexico (Medicare in Mexico).

United States-Mexico cross-border health insurance initiatives: Salud Migrante and Medicare in Mexico / Iniciativas transfronterizas de seguro de salud entre México y los Estados Unidos: Salud Migrante y Medicare en México

While U.S. health care reform will most likely reduce the overall number of uninsured Mexican-Americans, it does not address challenges related to health care coverage for undocumented Mexican immigrants, who will remain uninsured under the measures of the reform; documented low-income Mexican immigrants who have not met the five-year waiting period required for Medicaid benefits; or the growing number of retired U.S. citizens living in Mexico, who lack easy access to Medicare-supported services. This article reviews two promising binational initiatives that could help address these challenges-Salud Migrante and Medicare in Mexico; discusses their prospective applications within the context of U.S. health care reform; and identifies potential challenges to their implementation (legal, political, and regulatory), as well as the possible benefits, including coverage of uninsured Mexican immigrants, and their integration into the U.S. health care system (through Salud Migrante), and access to lower-cost Medicare-supported health care for U.S. retirees in Mexico (Medicare in Mexico).

Aunque la reforma del sector sanitario de los Estados Unidos muy probablemente reducirá el número global de ciudadanos estadounidenses de origen mexicano sin cobertura de atención de la salud, esta reforma no afronta los problemas relacionados con esta cobertura para los inmigrantes mexicanos indocumentados, quienes seguirán sin tener seguro aun tras la aplicación de las medidas de la reforma; para los inmigrantes mexicanos documentados de bajos ingresos que no han cumplido el período de espera de cinco años requerido para recibir las prestaciones de Medicaid; o para el número cada vez mayor de ciudadanos estadounidenses jubilados que viven en México y no pueden acceder con facilidad a los servicios de Medicare. En este artículo se analizan dos iniciativas binacionales prometedoras que podrían ayudar a afrontar estos retos: Salud Migrante y Medicare en México. Se tratan además sus futuras aplicaciones dentro del contexto de la reforma del sector sanitario de los Estados Unidos y se señalan los posibles retos para su ejecución (legales, políticos y reglamentarios), al igual que las posibles prestaciones, como la cobertura de los inmigrantes mexicanos no asegurados y su integración en el sistema de atención de la salud de los Estados Unidos (mediante Salud Migrante), y el acceso a atención de la salud de bajo costo, con el apoyo de Medicare, para los jubilados estadounidenses residentes en México (Medicare en México).

Predictors of mammography use in older women with disability: the patients' perspectives.

To determine the factors associated with mammography use among Medicare beneficiaries and reasons for nonuse. Cohort of 4610 community-dwelling Medicare beneficiaries ≥ 65 years included in the 2004-2005 Medicare Current Beneficiary Survey. Regression models evaluated the association of disability with mammography use. Reasons for underuse are described. Women with disability were more likely than women with no disability to report lower mammography use (unadjusted, moderate disability OR = 0.76; 95% CI = 0.64, 0.91; severe disability OR = 0.46; 95% CI = 0.40, 0.54). Lower use was significant for women with severe disability (adjusted, OR = 0.67; 95% CI = 0.54, 0.83) and women with fair-poor self-rated health, no HMO enrollment and ≥ 3 comorbidities. No physician recommendation, no need, dislike/pain during the test and forget it were reasons for underutilization. Mammography use decreases with increasing level of disability. Common reasons for underutilization are no physician recommendation, no need, dislike/pain during the test and forgot it. Screening guidelines should be used to target women with disabilities who can benefit from mammography.

The impact of rheumatoid arthritis on rehabilitation outcomes after lower extremity arthroplasty.

BACKGROUND: Medical rehabilitation after lower extremity arthroplasty is an integral part of recovery and a critical step in returning to independent mobility. We hypothesized that rehabilitation may take longer for patients with rheumatoid arthritis (RA) versus osteoarthritis (OA) because joint pain, swelling, and deformities are generally worse among persons with RA. OBJECTIVES: To determine the impact of RA on length of rehabilitation stay and rehabilitation functional status gain after arthroplasty. METHODS: We conducted a retrospective cohort analysis using a national registry of US medical rehabilitation inpatients admitted after a lower extremity arthroplasty between 1994 and 2001. Sample included 1361 patients with RA and 26,096 patients with OA. The main outcome measure was functional status gain as assessed by the functional independence measure (FIM). Our primary analytic method was linear regression. Covariates were age, gender, race/ethnicity, other comorbidity, admission FIM, and site of arthroplasty. RESULTS: Mean length of stay for patients with RA was 11.3 +/- 7.1 days (mean +/- standard deviation) versus 10.3 +/- 6.5 days for those with OA. Mean weekly gain was 18.6 +/- 12.1 for patients with RA versus 20.6 +/- 12.0 for those with OA. After adjusting for covariates, RA was associated with longer stay (0.7 day) and lower FIM gain (2.6). CONCLUSIONS: RA was associated with longer length of rehabilitation stay and lower FIM gain in patients with lower extremity arthroplasty. Such patients may require additional monitoring to ensure sufficient rehabilitation.

The relationship between depressive symptoms and shoulder mobility among older women: assessment at one year after breast cancer diagnosis.

OBJECTIVE: To examine the association between depressive symptoms and shoulder range of motion at one year after breast cancer diagnosis, controlling for patient characteristics, tumour stage and cancer therapy (surgery, axillary node dissection and radiation). DESIGN: Prospective trial of nurse case management involving 187 older women with complete data, age 60 years and older, newly diagnosed with breast cancer, from 1 November, 1993 to 31 October, 1996 in south-eastern Texas. Depressive symptoms, sociodemographic characteristics and breast cancer treatment were measured at two months and shoulder range of motion at 12 months. The relationship among the variables was evaluated with bivariate chi-square statistics and logistic regression analysis. All logistic models also included a variable indicating whether or not the woman received nurse case management, to control for intervention status. RESULTS: Increasing depressive symptoms at baseline were associated with lower arm mobility at 12 months following breast cancer diagnosis. Each unit increase in depressive symptoms at baseline was associated with an 8% decreased odds of having full range of motion of the shoulder (odds ratio (OR) 0.92, 95% confidence interval (CI) 0.87, 0.97), after controlling for relevant patient and treatment factors. CONCLUSION(S): Older women with depressive symptoms have an elevated risk of not fully recovering shoulder mobility after being treated for breast cancer. Future studies are needed to assess benefits from early intervention with psychological and or physical interventions in the presence of depressive symptoms on shoulder mobility.

Breast carcinoma treatment received by women with disabilities compared with women without disabilities.

BACKGROUND: Disability may make it difficult to lie flat or abduct the arm to deliver radiation therapy, imposing a high risk for radiation-induced side effects or difficulty in positioning patients for mammography. The goal of the current study was to determine the differences in treatment options experienced by women with physical disabilities compared with those without disabilities. METHODS: Chart review of 234 women who underwent surgery for breast carcinoma between June and September 1998 in a national comprehensive cancer center was conducted. Thirty-nine of the women had physical disabilities; the remaining 195 women were without disabilities. Hierarchical logistic regression was used to determine whether women with disabilities were less likely than women without disabilities to be treated with breast-conservation surgery (BCS) or neoadjuvant chemotherapy. RESULTS: Women with disabilities underwent BCS 38% of the time, whereas women without disabilities underwent BCS 49% of the time. Neither the presence nor absence of disability (P = 0.146) nor patient age (P = 0.747) were found to be significant predictors of BCS. However, the disease stage at the time of the surgery was reported to be a significant predictor of BCS (P = 0.007). The group of patients with disabilities received neoadjuvant chemotherapy 13% of the time, whereas women without disabilities received it 29% of the time. Disability was not found to be a significant predictor of whether a patient received neoadjuvant chemotherapy. Using hierarchical logistic regression, patient age was found to be a significant predictor of neoadjuvant chemotherapy before the disease stage was entered into the regression equation. There were no data to support the hypothesis that breast carcinoma is at an advanced stage when diagnosed in women with disabilities. CONCLUSIONS: These findings are clinically significant in that they indicate that women with disabilities are less likely to undergo BCS and are less likely to receive neoadjuvant chemotherapy compared with women without disabilities, but the difference did not reach statistical significance. To the authors' knowledge, there are no data to support the hypothesis that disabled women are diagnosed at a more advanced stage of disease compared with women without disabilities.