Impacts of insurance expansion on health cost, health access, and health behaviors: evidence from the medicaid expansion in the US

Evaluating catastrophic health expenditures among patients with long bone fractures in Ghana's major teaching hospitals: a hospital-based analysis

BACKGROUND

In low and middle-income countries like Ghana, out-of-pocket (OOP) payments remain a significant barrier to healthcare access, often leading to catastrophic health expenditures (CHE). This study evaluates the incidence of CHE among patients treated for long bone fractures at Ghana's major teaching hospitals, providing insight into the economic burdens faced by these patients.

METHODS

This cross-sectional study analyzed data from 2,980 patients with long bone fractures treated at four major teaching hospitals in Ghana from July 2017 to July 2020. We collected demographic, clinical, and economic data, including OOP payments and patient-reported income, to assess the incidence of CHE at varying income thresholds (10%, 20%, 30%, 40%). Logistic regression models were used to identify predictors of CHE, with variables including age, gender, education, region, fracture type, injury severity, and NHIS coverage.

RESULTS

The incidence of CHE was highest at the 10% income threshold (53.21%) and decreased with higher thresholds. Male patients incurred higher average OOP payments ($343.68) than females ($271.63), and patients with tibia fractures faced the highest financial burden. Educational and regional disparities were evident, with lower CHE rates among patients with higher educational attainment and those from northern regions. NHIS coverage provided limited financial relief, particularly at lower income thresholds.

CONCLUSION

Long bone fractures impose a substantial financial burden on patients in Ghana, with significant gender, educational, and regional disparities in OOP payments and CHE. While NHIS provides some relief, it remains inadequate in protecting patients from financial distress. Policy interventions aimed at expanding NHIS coverage, reducing OOP payments for high-cost treatments, and addressing geographic inequities are urgently needed to improve financial protection for patients with long bone fractures in Ghana. Future research should focus on capturing long-term financial impacts and improving income data accuracy to better inform healthcare policies.

Relationship between characteristics of large national regions and individual alcohol consumption: a scoping review

OBJECTIVE

The goal of our article was to systematise studies that investigated the impact of living conditions in large national regions on individual alcohol consumption.

METHODS

The objectives of the scoping review, the criteria and methods for selecting articles were defined in advance and recorded in the protocol PROSPERO CRD42021234874. We sought publications on the research topic in PubMed, Google Scholar, OpenGrey, Crossref and eLibrary databases from the moment they were created until December 31, 2021. The final sample included 81 publications.

RESULTS

The majority of ultimately selected papers were published after 2010 (62 articles), represented the USA (68 articles), and considered samples of children and youths, either the younger population or the general adult population (65 articles). High quality was characteristic for 19 studies, whereas satisfactory quality was exhibited by 46 publications. The most consistent associations with individual alcohol consumption were revealed for the legislative environment (especially for integral scales and indices), alcohol pricing policy, the prevalence of alcohol consumption and binge drinking in the population, and unemployment rate.

CONCLUSION

The review made it possible to systematise the results of studies on the impact of the characteristics of large national regions on alcohol consumption, including a description of these characteristics and results, samples and designs of studies, their quality, as well as to summarise the results of these studies.

Virginia Medicaid Expansion: New Members Report Reduced Financial Concerns During The COVID-19 Pandemic

Medicaid is a critical antipoverty program. Since the Affordable Care Act expanded Medicaid eligibility, millions of newly eligible people have enrolled, creating positive financial improvements for low-income families. We examined the association of Virginia's 2019 Medicaid expansion and changes in health care-related and non-health-care-related financial needs among newly eligible Medicaid enrollees. Our unique survey collected responses between December 2018 and April 2019 from newly enrolled members reporting on experiences in the year before enrollment and between July 2020 and May 2021 from members reporting on experiences one year after enrollment. The follow-up period coincided with the COVID-19 pandemic. Medicaid enrollment was associated with decreases in concern about all financial needs assessed: housing, food, monthly bills, credit card and loan payments, and health care costs. These reductions were broadly similar across demographic subgroups and across the months of the pandemic that overlapped with the follow-up period. We add to the evidence that Medicaid expansion is a social safety-net policy that could improve equity among low-income families, potentially encouraging states that have yet to expand to do so.