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1.
Plast Reconstr Surg ; 145(2): 545-554, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985657

RESUMO

BACKGROUND: Following bariatric surgery, patients develop problems related to lax abdominal skin that may be addressed by contouring procedures. Third-party insurers have subjective requirements for coverage of these procedures that can limit patient access. The authors sought to determine how well third-party payers cover abdominal contouring procedures in this population. METHODS: The authors conducted a cross-sectional analysis of insurance policies for coverage of panniculectomy, lower back excision, and circumferential lipectomy. Abdominoplasty was evaluated as an alternative to panniculectomy. Insurance companies were selected based on their market share and state enrolment. A list of medical necessity criteria was abstracted from the policies that offered coverage. RESULTS: Of the 55 companies evaluated, 98 percent had a policy that covered panniculectomy versus 36 percent who would cover lower back excision (p < 0.0001), and one-third provided coverage for circumferential lipectomy. Of the insurers who covered panniculectomy, only 30 percent would also cover abdominoplasty. Documentation of secondary skin conditions was the most prevalent criterion in panniculectomy policies (100 percent), whereas impaired function and secondary skin conditions were most common for coverage of lower back excision (73 percent and 73 percent, respectively). Frequency of criteria for panniculectomy versus lower back excision differed most notably for (1) secondary skin conditions (100 percent versus 73 percent; p = 0.0030), (2) weight loss (45 percent versus 7 percent; p = 0.0106), and (3) duration of weight stability (82 percent versus 53 percent; p = 0.0415). CONCLUSIONS: For the postbariatric population, panniculectomy was covered more often and had more standardized criteria than lower back excision or circumferential lipectomy. However, all have vast intracompany and interpolicy variations in coverage criteria that may reduce access to procedures, even among patients with established indications.


Assuntos
Abdominoplastia/economia , Cirurgia Bariátrica/economia , Contorno Corporal/economia , Cobertura do Seguro/economia , Seguro Saúde/estatística & dados numéricos , Abdominoplastia/estatística & dados numéricos , Dorso/cirurgia , Estudos Transversais , Humanos , Seguradoras/economia , Seguradoras/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/economia , Lipectomia/economia , Lipectomia/estatística & dados numéricos , Cuidados Pós-Operatórios/economia , Estados Unidos
2.
N C Med J ; 81(1): 51-54, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908336

RESUMO

Medicaid is an essential source of health coverage that finances more than half of all births in North Carolina. This paper examines current eligibility for pregnant women and its impacts on health outcomes for mothers and children. The authors provide suggestions to increase access to this vital health insurance program and better promote the health of North Carolina's families.


Assuntos
Cobertura do Seguro/estatística & dados numéricos , Medicaid , Criança , Saúde da Criança , Definição da Elegibilidade , Feminino , Humanos , Saúde Materna , North Carolina , Gravidez , Estados Unidos
3.
Anticancer Res ; 39(11): 6359-6363, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704868

RESUMO

BACKGROUND/AIM: To analyze whether demographic and facility type characteristics cause inequality in the type of biopsy performed in patients with cutaneous melanoma. PATIENTS AND METHODS: The skin cancer National Cancer Database was assessed. Men and women of all ages with cutaneous melanoma in situ and malignant melanoma at any stage of the disease were included. Patients were selected who underwent one of the following biopsy types: excisional, punch, shave, or incisional. Bivariate and multivariate analyses were performed. RESULTS: We found that the likelihood of undergoing an excisional biopsy decreased in patients who were: Hispanic [odds ratio (OR)=0.63, confidence interval (CI)=0.55-0.71], non-White (OR=0.66, CI=0.58-0.76), older than 80 years (OR=0.77, CI=0.72-0.87), or in Comprehensive Community Cancer Programs (OR=0.33, CI=0.31-0.36), Community Cancer Programs (OR=0.52, CI=0.50-0.54) and Integrated Network Cancer Programs (OR=0.58, CI=0.55-0.61). CONCLUSION: Our study results demonstrate disparities in biopsy type in the treatment of melanoma.


Assuntos
Biópsia/métodos , Disparidades em Assistência à Saúde , Melanoma/patologia , Neoplasias Cutâneas/patologia , Padrão de Cuidado , Fatores Etários , Biópsia/normas , Grupos de Populações Continentais , Grupos Étnicos , Feminino , Disparidades em Assistência à Saúde/etnologia , Hispano-Americanos , Humanos , Cobertura do Seguro/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Análise de Regressão , Características de Residência , Fatores Sexuais , Fatores Socioeconômicos
4.
BMC Health Serv Res ; 19(1): 779, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31675975

RESUMO

BACKGROUND: Despite extensive research concerning the impact of health insurance on the advancement of infant health in developed countries, few studies have adjusted their results for potential confounding due to adverse selection in insurance coverage, wherein those who anticipate a need for health services tend to be the ones that acquire insurance. The presence of compulsory health insurance in China, such as the Urban Employee Basic Medical Insurance (UEBMI) scheme may provide an opportunity to estimate the effect of health insurance on infant health, by reducing the endogeneity problem into insurance due to the adverse selection. The objective is to assess the relationship between UEBMI and infant health outcomes in one sizeable municipal-level obstetrics hospital in Shanghai, East China. METHODS: Medical records data from the Shanghai First Maternity and Infant Hospital from January 1, 2013 to April 30, 2019 were used to form an analysis dataset of 160,429 live births which was comprised of Shanghai residents with UEBMI coverage (n = 101,153) and women without any insurance coverage (n = 59,276). A propensity score matching approach using conjoint quantile regression and probit regression models was used to eliminate latent endogeneity of UEBMI coverage in order to garner robust results. Further analysis stratified by maternal migrant status was conducted to further assess the sensitivity of the findings to distinct patient subgroups. RESULTS: The UEBMI scheme was shown to be associated with improvements in infant birth outcomes. The scheme was associated with: an increase in birth weight of about 30 g (p <  0.001, 95% CI 23.908-35.295). This finding was evident in other five different birth outcomes (premature birth, low birth weight, very low birth weight, low Apgar score, and an abnormal health condition at birth). After stratifying by migrant status, the UEBMI was shown to have a greater effect on migrants compared to local residents of Shanghai. CONCLUSIONS: Our findings suggest that health insurance coverage for pregnant women, especially for migrants, has the potential to significantly and directly improve infant health outcomes. Further research is required to determine whether these findings can be replicated for other Chinese jurisdictions.


Assuntos
Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Resultado da Gravidez , Adulto , China , Feminino , Humanos , Recém-Nascido , Gravidez , Migrantes/estatística & dados numéricos , População Urbana/estatística & dados numéricos
5.
Med Care ; 57(11): 861-868, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31634267

RESUMO

OBJECTIVES: We examined changes in health care access and utilization associated with the Patient Protection and Affordable Care Act (ACA) for different Asian American subgroups relative to non-Latino whites (whites). RESEARCH DESIGN: Using 2003-2017 California Health Interview Survey data, we examined changes in 4 health care access measures and 2 utilization measures among whites and 7 Asian American subgroups. We estimated the unadjusted and adjusted percentage point changes on the absolute scale from the pre-ACA to post-ACA periods. Adjusted estimates were obtained from multivariable logistic regression models that controlled for predisposing, enabling, and need factors. We also estimated the pre-ACA to post-ACA changes between whites and Asian American subgroups using a difference-in-difference approach. RESULTS: After the ACA was implemented, uninsurance decreased among all Asian American subgroups, but improvements in disparities relative to whites in these measures were limited. In particular, Koreans had the largest absolute reduction in uninsurance (-16.8 percentage points) and were the only subgroup with a significant reduction in terms of disparities relative to whites (-10.1 percentage points). However, little or no improvement was observed in the other 3 access measures (having a usual source of care, delayed medical care in past year, or delayed prescription drug use in past year) and 2 utilization measures (having a physician visit or emergency department visit in past year). CONCLUSIONS: Despite coverage gains among Asian American subgroups, especially Koreans, disparities in access and utilization persisted across all Asian American subgroups.


Assuntos
Americanos Asiáticos/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Patient Protection and Affordable Care Act , Adulto , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Disparidades em Assistência à Saúde , Humanos , Cobertura do Seguro/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
6.
BMC Public Health ; 19(1): 1350, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640647

RESUMO

BACKGROUND: Despite the availability of evidence-based treatment, there is a substantial gap between the number of individuals in need of mental health care and those who receive treatment. The aim of this study was to assess changes in treatment coverage and barriers to mental health care among adults with depression and alcohol use disorder (AUD) before and after implementation of a district mental health care plan (MHCP) in Nepal. METHODS: The repeat population-based cross-sectional community survey was conducted with randomly selected adults in the baseline (N = 1983) and the follow-up (N = 1499) surveys, 3 years and 6 months apart. The Patient Health Questionnaire and Alcohol Use Disorder Identification Test were used to screen people with probable depression and AUD. Barriers to seeking mental health care were assessed by using a standardized tool, the Barriers to Care Evaluation Scale (BACE). RESULTS: The proportion of the participants receiving treatment for depression increased by 3.7 points (from 8.1% in the baseline to 11.8% in the follow-up) and for AUD by 5.2 points (from 5.1% in the baseline to 10.3% in the follow-up study), however, these changes were not statistically significant. There was no significant reduction in the overall BACE score in both unadjusted and adjusted models for both depression and AUD. The possible reasons for non-significant changes in treatment coverage and barriers to care could be that (i) the method of repeat population level surveys with a random sample was too distal to the intervention to be able to register a change and (ii) the study was underpowered to detect such changes. CONCLUSION: The study found non-significant trends for improvements in treatment coverage and barriers to mental health care following implementation of the district mental health care plan. The key areas for improvement in the current strategy to improve treatment coverage and barriers to mental health care included change in the content of the existing community sensitization program, particularly for changing attitude and intention of people with mental illness for seeking care.


Assuntos
Alcoolismo/terapia , Depressão/terapia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Serviços de Saúde Mental , Adolescente , Adulto , Alcoolismo/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Seguimentos , Humanos , Seguro Saúde/organização & administração , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Adulto Jovem
7.
Health Serv Res ; 54(6): 1193-1202, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31657003

RESUMO

OBJECTIVE: To examine the impact of Oregon's Coordinated Care Organizations (CCOs), an accountable care model for Oregon Medicaid enrollees implemented in 2012, on neonatal and infant mortality. DATA SOURCES: Oregon birth certificates linked with death certificates, and Medicaid/CCO enrollment files for years 2008-2016. STUDY DESIGN: The sample consisted of the pre-CCO birth cohort of 135 753 infants (August 2008-July 2011) and the post-CCO birth cohort of 148 650 infants (August 2012-December 2015). We used a difference-in-differences probit model to estimate the difference in mortality between infants enrolled in Medicaid and infants who were not enrolled. We examined heterogeneous effects of CCOs for preterm and full-term infants and the impact of CCOs over the implementation timeline. All models were adjusted for maternal and infant characteristics and secular time trends. PRINCIPAL FINDINGS: The CCO model was associated with a 56 percent reduction in infant mortality compared to the pre-CCO level (-0.20 percentage points [95% CI: -0.35; -0.05]), and also with a greater reduction in infant mortality among preterm infants compared to full-term infants. The impact on mortality grew in magnitude over the postimplementation timeline. CONCLUSIONS: The CCO model contributed to a reduction in mortality within the first year of birth among infants enrolled in Medicaid.


Assuntos
Organizações de Assistência Responsáveis/estatística & dados numéricos , Mortalidade Infantil , Cobertura do Seguro/estatística & dados numéricos , Programas de Assistência Gerenciada/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Pobreza , Adulto , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Oregon , Estados Unidos
8.
Health Serv Res ; 54(6): 1263-1272, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31602631

RESUMO

OBJECTIVE: To measure discordance between aggregate estimates of means-tested coverage from the American Community Survey (ACS) and administrative counts and examine the association of discordance with ACA Medicaid expansion. DATA SOURCES: 2010-2016 ACS and counts of Medicaid and Children's Health Insurance Program enrollment from the Centers for Medicare & Medicaid Services. STUDY DESIGN: State-by-year counts of means-tested coverage from the ACS were compared to administrative counts using percentage differences. Discordance was compared for states that did and did not adopt expansion using difference-in-differences. We then contrasted the effect of expansion on means-tested coverage estimated from the ACS with results from administrative data. DATA COLLECTION/EXTRACTION: Survey and administrative data. PRINCIPAL FINDINGS: One year before expansion there was a 0.8 and 4 percent overcount in expansion and nonexpansion states, respectively. By 2016, there was a 10.64 percent undercount in expansion states vs a 0.02 percent undercount in nonexpansion states. The ACS suggests that expansion increased means-tested coverage in the full population by three percentage points, relative to five percentage points suggested by administrative records. CONCLUSIONS: Discordance between the ACS and administrative records has increased over time. The ACS underestimates the impact of Medicaid expansion, relative to administrative counts.


Assuntos
Children's Health Insurance Program/estatística & dados numéricos , Confiabilidade dos Dados , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Governo Estadual , Estados Unidos
9.
Int J Equity Health ; 18(1): 159, 2019 10 17.
Artigo em Inglês | MEDLINE | ID: mdl-31623613

RESUMO

BACKGROUND: The human papillomavirus (HPV) is the most common sexually transmitted infection (STI) worldwide. Gay, bisexual, and other men who have sex with men (GBM), and GBM living with HIV in particular, are disproportionately impacted by HPV-associated cancers. The HPV vaccine, given early enough in life, may markedly reduce the likelihood of such cancers. In Canada, most provincial insurance programs only cover HPV vaccination for GBM up to the age of 26. Our objective was to understand physicians' everyday experiences and challenges in recommending HPV vaccination to older GBM patients. METHODS: As part of the HPV Screening and Vaccine Evaluation (HPV-SAVE) Study, we conducted semi-structured interviews with 25 HIV-positive GBM patients who had received anal cancer screening and 15 service providers, including 13 physicians, who had arranged for anal cancer screening in the Canadian provinces of Ontario and British Columbia. In this analysis, we draw upon the 13 physician interviews, which were coded following Grounded Theory. RESULTS: Physicians strongly supported the HPV vaccine for all GBM and considered it to be important for the management of HIV-related care. However, the overall support for HPV vaccination among physicians did not translate into consistent recommendation practices. There were two overarching factors that limited the strength/frequency of physicians' vaccine recommendation practices. First, cost/insurance coverage for some older patients impacted if and how the HPV vaccine was discussed. Second, physicians had diverse perspectives on both the prevention and therapeutic benefits of vaccinating older GBM and the reality that national guidelines are incongruent with publicly funded vaccine programs for vaccinating patients over 26 years old. These two interrelated factors have co-produced an apparent economic-evidentiary conundrum for many physicians regarding how and for whom to offer HPV vaccination. CONCLUSION: Economic barriers coupled with evidentiary and guideline gaps have created clinical practice challenges for physicians and has resulted in different messages being communicated to some older GBM patients about how important HPV vaccination is for their health.


Assuntos
Homossexualidade Masculina , Vacinas contra Papillomavirus/administração & dosagem , Médicos/psicologia , Padrões de Prática Médica , Minorias Sexuais e de Gênero , Adulto , Canadá , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Cobertura do Seguro/estatística & dados numéricos , Masculino , Vacinas contra Papillomavirus/economia , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/economia , Padrões de Prática Médica/ética , Pesquisa Qualitativa , Minorias Sexuais e de Gênero/estatística & dados numéricos , Fatores Socioeconômicos
10.
Plast Reconstr Surg ; 144(4): 824-833, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31568285

RESUMO

BACKGROUND: Despite the medical necessity, legislative mandates, and economic benefits of gender-affirming surgery, access to treatment remains limited. The World Professional Association for Transgender Health (WPATH) has proposed guidelines for transition-related surgery in conjunction with criteria to delineate medical necessity. The authors assessed insurance coverage of "top" gender-affirming surgery and evaluated the differences between insurance policy criteria and WPATH recommendations. METHODS: The authors conducted a cross-sectional analysis of insurance policies for coverage of top gender-affirming surgery. Insurance companies were selected based on their state enrollment data and market share. A Web-based search and individual telephone interviews were conducted to identify the policy. Medical necessity criteria were abstracted from publicly available policies. RESULTS: Of the 57 insurers evaluated, bilateral mastectomy (transmasculine) was covered by significantly more insurers than breast augmentation (transfeminine) (96 percent versus 68 percent; p < 0.0001). Only 4 percent of companies used WPATH-consistent criteria. No criterion was universally required by insurers. Additional prerequisites for coverage that extended beyond WPATH guidelines for top surgery were continuous living in congruent gender role, two referring mental health professionals, and hormone therapy before surgery. Hormone therapy was required in a significantly higher proportion of transfeminine policies compared with transmasculine policies (90 percent versus 21 percent; p < 0.0001). CONCLUSIONS: In addition to the marked intercompany variation in criteria for insurance coverage that often deviated from WPATH recommendations, there are health care insurers who categorically deny access to top gender-affirming surgery. A greater evidence base is needed to provide further support for the medical necessity criteria in current use.


Assuntos
Cobertura do Seguro/estatística & dados numéricos , Cobertura do Seguro/normas , Cirurgia de Readequação Sexual , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto , Estados Unidos , Adulto Jovem
11.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31554667

RESUMO

BACKGROUND AND OBJECTIVES: Asthma is responsible for ∼1.7 million emergency department (ED) visits annually in the United States. Studies in adults have shown that anxiety and depression are associated with increased asthma-related ED use. Our objective was to assess this association in pediatric patients with asthma. METHODS: We identified patients aged 6 to 21 years with asthma in the Massachusetts All-Payer Claims Database for 2014 to 2015 using International Classification of Diseases, Ninth and 10th Revision codes. We examined the association between the presence of anxiety, depression, or comorbid anxiety and depression and the rate of asthma-related ED visits per 100 child-years using bivariate and multivariable analyses with negative binomial regression. RESULTS: Of 65 342 patients with asthma, 24.7% had a diagnosis of anxiety, depression, or both (11.2% anxiety only, 5.8% depression only, and 7.7% both). The overall rate of asthma-related ED use was 17.1 ED visits per 100 child-years (95% confidence interval [CI]: 16.7-17.5). Controlling for age, sex, insurance type, and other chronic illness, patients with anxiety had a rate of 18.9 (95% CI: 17.0-20.8) ED visits per 100 child-years, patients with depression had a rate of 21.7 (95% CI: 18.3-25.0), and patients with both depression and anxiety had a rate of 27.6 (95% CI: 24.8-30.3). These rates were higher than those of patients who had no diagnosis of anxiety or depression (15.5 visits per 100 child-years; 95% CI: 14.5-16.4; P < .001). CONCLUSIONS: Children with asthma and anxiety or depression alone, or comorbid anxiety and depression, have higher rates of asthma-related ED use compared with those without either diagnosis.


Assuntos
Ansiedade/epidemiologia , Asma/epidemiologia , Depressão/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Adolescente , Algoritmos , Criança , Comorbidade , Intervalos de Confiança , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Cobertura do Seguro/estatística & dados numéricos , Masculino , Massachusetts/epidemiologia , Prevalência , Análise de Regressão , Adulto Jovem
12.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31558576

RESUMO

OBJECTIVES: To study the national prevalence of 10 developmental disabilities in US children aged 3 to 17 years and explore changes over time by associated demographic and socioeconomic characteristics, using the National Health Interview Survey. METHODS: Data come from the 2009 to 2017 National Health Interview Survey, a nationally representative survey of the civilian noninstitutionalized population. Parents reported physician or other health care professional diagnoses of attention-deficit/hyperactivity disorder; autism spectrum disorder; blindness; cerebral palsy; moderate to profound hearing loss; learning disability; intellectual disability; seizures; stuttering or stammering; and other developmental delays. Weighted percentages for each of the selected developmental disabilities and any developmental disability were calculated and stratified by demographic and socioeconomic characteristics. RESULTS: From 2009 to 2011 and 2015 to 2017, there were overall significant increases in the prevalence of any developmental disability (16.2%-17.8%, P < .001), attention-deficit/hyperactivity disorder (8.5%-9.5%, P < .01), autism spectrum disorder (1.1%-2.5%, P < .001), and intellectual disability (0.9%-1.2%, P < .05), but a significant decrease for any other developmental delay (4.7%-4.1%, P < .05). The prevalence of any developmental disability increased among boys, older children, non-Hispanic white and Hispanic children, children with private insurance only, children with birth weight ≥2500 g, and children living in urban areas and with less-educated mothers. CONCLUSIONS: The prevalence of developmental disability among US children aged 3 to 17 years increased between 2009 and 2017. Changes by demographic and socioeconomic subgroups may be related to improvements in awareness and access to health care.


Assuntos
Deficiências do Desenvolvimento/epidemiologia , Adolescente , Fatores Etários , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Espectro Autista/epidemiologia , Cegueira/epidemiologia , Paralisia Cerebral/epidemiologia , Criança , Pré-Escolar , Escolaridade , Feminino , Perda Auditiva/epidemiologia , Humanos , Cobertura do Seguro/estatística & dados numéricos , Deficiência Intelectual/epidemiologia , Masculino , Dinâmica Populacional , Prevalência , Convulsões/epidemiologia , Fatores Sexuais , Fatores Socioeconômicos , Gagueira/epidemiologia , Estados Unidos/epidemiologia
13.
Health Serv Res ; 54(6): 1166-1173, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31385302

RESUMO

OBJECTIVE/STUDY QUESTION: To examine changes in uninsurance rates among U.S. adolescents ages 12-17 and assess whether trends over time differed by citizenship status, Latino ethnicity, and household language. DATA SOURCES/STUDY SETTING: 2007-2016 National Health Insurance Survey (NHIS). STUDY DESIGN: Multivariable logistic regression and postestimation marginal effects were used to assess changes in the current uninsured rate. Logistic regression models were used to determine significant trends over time for each demographic group and compare them to trends in the broader adolescent population. Marginal effects were employed to calculate adjusted outcome probabilities for each year. PRINCIPAL FINDINGS: Across all 12- to 17-year-olds, the unadjusted uninsured rate dropped significantly between 2007 and 2016, from 10.2 percent to 6.0 percent. For noncitizen youth, the probability of being uninsured increased from 26.6 percent in 2007 to 28.4 percent in 2016, after controlling for covariates. Latino youth and those in Spanish-speaking households saw declines in their adjusted uninsurance rate that was proportional to non-Latino and English-speaking youth. CONCLUSIONS: Most adolescents saw significant improvements in health insurance coverage between 2007 and 2016; however, disparities remain among Spanish-speaking and Latino adolescents and no improvements were seen among noncitizen youth. This suggests a need for equity-focused eligibility, outreach, and enrollment policies that expand insurance options for these populations.


Assuntos
Definição da Elegibilidade/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Adolescente , Criança , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Masculino , Fatores Socioeconômicos , Estados Unidos/etnologia
14.
Med Care ; 57(10): 781-787, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31433313

RESUMO

BACKGROUND: Low-income adults in the United States have historically had limited access to dental coverage and poor dental health outcomes. OBJECTIVE: We examined the effects of the Affordable Care Act Medicaid expansions on dental visits among low-income adults focusing on the generosity of dental coverage and heterogeneity in effects by dentist supply. RESEARCH DESIGN: We used data from 2012, 2014, and 2016 Behavioral Risk Factor Surveillance System surveys. The main analytical sample included nearly 117,000 individuals <138% federal poverty level. We employed a quasi-experimental difference-in-differences design to identify the impact of the state Medicaid expansions on having a dental visit in the past 12 months by the generosity of dental coverage and dentist supply. RESULTS: Medicaid expansions were associated with a nearly 6 percentage-point increase in the likelihood of any dental visits in 2016 (over 10% increase from preexpansion rate) for individuals in Medicaid expanding states with extensive dental benefits. This increase, however, was concentrated in states with high dentist supply with no evidence of improvement in utilization in states with limited dental coverage or low dentist supply. CONCLUSIONS: Expanding Medicaid with generous dental coverage improved dental care use only in areas with high dentist supply with no evidence of benefits with low dentist supply or less generous coverage. Improving access to dental care may require both generous coverage and supply-side interventions to increase dentist availability.


Assuntos
Assistência Odontológica/estatística & dados numéricos , Odontólogos/provisão & distribução , Cobertura do Seguro/estatística & dados numéricos , Seguro Odontológico/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Medicaid/legislação & jurisprudência , Patient Protection and Affordable Care Act , Pobreza/estatística & dados numéricos , Estados Unidos
15.
Med Care ; 57(8): 567-573, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31299024

RESUMO

BACKGROUND: Every year, millions of Americans lose their health insurance and remain uninsured for various reasons, potentially impacting access to medical services. OBJECTIVE: To examine trends in health insurance loss in the periods shortly before and after implementation of Patient Protection and Affordable Care Act (ACA) and to assess the association of past-year health insurance loss with access to health services and medications. RESEARCH DESIGN AND SUBJECTS: Trends in health insurance loss were examined in 176,961 nonelderly adult participants of the National Health Interview Survey 2011-2017-a representative cross-sectional annual survey of US general population. Multivariable logistic regression models were used to examine access to health services and medications. MEASURES: Loss of private insurance or Medicaid in the past year; use of emergency room services and hospitalizations; contact with medical providers; affording medical care or medications; cost-related medication nonadherence. RESULTS: Private health insurance loss decreased from 3.9%-4.0% in 2011-2013 to 2.7% to 3.1% in 2014-2017 (P<0.001); Medicaid loss decreased from 8.5%-8.9% to 4.6%-6.4% in this period (P<0.001). Nevertheless, as late as 2017, ∼6 million uninsured adults reported having lost private insurance or Medicaid in the past year. Loss of either type of health insurance was associated with lower odds of accessing medical providers, but higher odds of not affording medical care and poor adherence to medication regimens to save costs. CONCLUSIONS: Implementation of ACA was associated with lower risk of health insurance loss. Nevertheless, health insurance loss remains a major barrier to accessing health services and prescribed medications.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Patient Protection and Affordable Care Act/estatística & dados numéricos , Adolescente , Adulto , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/legislação & jurisprudência , Hospitalização/estatística & dados numéricos , Humanos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/legislação & jurisprudência , Modelos Logísticos , Masculino , Medicaid/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/legislação & jurisprudência , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
16.
J Autism Dev Disord ; 49(10): 4320-4331, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31342443

RESUMO

This study examined children with an autism spectrum disorder (ASD) using data from the 2011 Survey of Pathway to Diagnosis and Services national data set (n = 1715). When comparing white and minority families, results indicate there were no differences between the child's treatment needs based on the number and type of ASD symptoms or insurance coverage. However, minority parents were less likely to contact a doctor or health care professionals about their concerns, waiting years, rather than months as described by white families, to have the child evaluated. Although both white and minority families received similar types of care (e.g., conducting developmental tests, making a referral to a specialist, suggesting that the parent discuss the concern with the school), white families reported they were more formally engaged in the diagnostic process and subsequently visited a larger variety of service providers. White parents were more satisfied with the services that their child received from doctors and other health care providers whereas minority families indicated school services were more responsiveness to their needs. Recommended outreach efforts are suggested and described.


Assuntos
Transtorno do Espectro Autista/epidemiologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/terapia , Criança , Pré-Escolar , Feminino , Humanos , Cobertura do Seguro/estatística & dados numéricos , Masculino , Estados Unidos
17.
Am J Public Health ; 109(9): 1236-1242, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31318591

RESUMO

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.


Assuntos
Nível de Saúde , Cobertura do Seguro/estatística & dados numéricos , Patient Protection and Affordable Care Act/estatística & dados numéricos , Adulto , Humanos , Medicaid , Pessoa de Meia-Idade , Saúde Pública , Qualidade de Vida , Estados Unidos/epidemiologia
18.
Public Health Rep ; 134(5): 542-551, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31269411

RESUMO

OBJECTIVES: In 2011, Wisconsin introduced the 2003 Revision of the US Standard Certificate of Live Birth, which includes a variable for principal payer. This variable could help in estimating Medicaid coverage for delivery services, but its accuracy in most states is not known. Our objective was to validate Medicaid payer classification on Wisconsin birth records. METHODS: We linked 128 141 Wisconsin birth records (2011-2012 calendar years) to 54 600 Medicaid claims. Using claims as the gold standard, we measured the payer variable's validity (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV]) overall and by maternal age, race/ethnicity, education, facility delivery volume, and the Medicaid proportion of facility delivery volume. Multivariable log-binomial regression tested the association between each characteristic and payer misclassification among Medicaid-paid births. RESULTS: Of 128 141 birth records, 50 652 (39.5%) indicated Medicaid as the principal payer and 54 600 (42.6%) linked to a Medicaid claim. The birth record misclassified 10 007 of 54 600 (18.3%) Medicaid-paid births as non-Medicaid and 6059 of 73 541 (8.2%) non-Medicaid births as Medicaid-paid. The payer variable was less sensitive (81.7%) than specific (91.8%), and PPV and NPV were similar (∼88%). Sensitivity was highest among mothers who were Hispanic, had no high school diploma, or delivered in Medicaid-majority delivery facilities. Maternal age ≥40, maternal education >high school, and delivering in a non-Medicaid-majority delivery facility were positively associated with payer misclassification among Medicaid-paid births. CONCLUSION: Differential misclassification of principal payer in the birth record may bias risk surveillance of Medicaid deliveries.


Assuntos
Declaração de Nascimento , Cobertura do Seguro/classificação , Medicaid , Adolescente , Adulto , Saúde da Criança , Feminino , Humanos , Cobertura do Seguro/estatística & dados numéricos , Saúde Materna , Estados Unidos , Wisconsin , Adulto Jovem
19.
Health Serv Res ; 54(5): 1099-1109, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31287571

RESUMO

OBJECTIVE: To measure the accuracy of survey-reported data on features and type of health insurance coverage. DATA SOURCE: Enrollment records from a private insurer were used as sample for primary survey data collection in spring of 2015 using the Current Population Survey health insurance module. STUDY DESIGN: A reverse record check study where households with individuals enrolled in a range of public and private health insurance plans (including the marketplace) were administered a telephone survey that included questions about general source of coverage (eg, employer), program name (eg, Medicaid), portal, premium, and subsidies. DATA COLLECTION/EXTRACTION METHODS: Survey data were matched back to enrollment records, which indicated coverage status at the time of the survey. Concordance between the records and survey data was assessed. PRINCIPAL FINDINGS: Correct reporting of general source of coverage ranged from 77.8 percent to 98.3 percent across coverage type, premium ranged from 91.6 percent to 96.4 percent, and subsidy ranged from 83.0 percent to 91.0 percent. Using a conceptual algorithm to categorize coverage type resulted in sensitivity of 98.3 percent for employer-sponsored enrollees, and 70.6 percent-77.6 percent for the other coverage types, while specificity ranged from 93.9 percent to 99.4 percent across coverage types. CONCLUSIONS: Survey reports of features of coverage suggest they are viable items to include in an algorithm to categorize coverage type. Findings have implications beyond the CPS, particularly for marketplace enrollees.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Medicare/estatística & dados numéricos , Planos Governamentais de Saúde/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Inquéritos e Questionários , Estados Unidos
20.
NCHS Data Brief ; (336): 1-8, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31163015

RESUMO

Routine dental care can promote oral health (1,2), and those with private dental insurance are more likely to visit a dentist than those with other types of dental coverage or no coverage (3,4). Geographical variation in dental coverage and care among adults under age 65 exists (5,6), as does the availability of dental health professionals (7). This report examines regional variation in dental coverage among dentate adults (i.e., adults who have not lost all permanent teeth) aged 18-64 who had private health insurance in the past year, their utilization of dental care, and unmet dental needs due to cost in the past year.


Assuntos
Assistência Odontológica/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Odontológico/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Adolescente , Adulto , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
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