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van Midde M, Hesse I, van der Heijden GJ, Duijster D, van Elteren M, Kroesen M, Agyemang C, Beune E. Access to oral health care for undocumented migrants: Perspectives of actors involved in a voluntary dental network in the Netherlands. Community Dent Oral Epidemiol 2020; 49:330-336. [PMID: 33341949 DOI: 10.1111/cdoe.12605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Undocumented migrants in Europe face multiple barriers in access to oral health care. This study aimed to explore the accessibility of a voluntary dental network providing dental treatments to undocumented migrants in the Netherlands, from the perspectives of patients, dentists and staff members of nongovernmental organizations involved. METHODS This qualitative study used semi-structured interviews (n = 21) with undocumented migrants (n = 12), dentists (n = 7) and staff members of nongovernmental organizations (n = 2) during the implementation of a voluntary dental network. Interviews were analysed using a framework analysis method. RESULTS As a temporary answer to problems in access to oral health for undocumented migrants, the voluntary dental network targeted initial barriers to dental care. Main challenges within the network were conflicting expectations and perceived treatment outcomes by patients, dentist and NGO staff members, limited financial resources, logistic and communication barriers and an increasing administrative burden. Furthermore, feelings of compassion for and trust of the patient affected the ethics of the professional relationship and influenced treatment decisions of dentists. CONCLUSION Through the implementation of a voluntary dental network, treatments could be provided to undocumented migrants as a temporary solution. However, the voluntary nature of dental care in the network resulted in a fragmented provision of oral health care among undocumented migrants. To reduce inequalities in oral health on the long term, systemic barriers in access to oral health care need to be addressed.
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Affiliation(s)
- Myrthe van Midde
- Research Department, Doctors of the World - the Netherlands, Amsterdam, The Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Iris Hesse
- Research Department, Doctors of the World - the Netherlands, Amsterdam, The Netherlands
| | - Geert Jmg van der Heijden
- Department of Social Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Denise Duijster
- Department of Social Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Marianne van Elteren
- Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam University Medical Centre location VUMC, Amsterdam, The Netherlands
| | - Margreet Kroesen
- Research Department, Doctors of the World - the Netherlands, Amsterdam, The Netherlands
| | - Charles Agyemang
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Erik Beune
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
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Abstract
Purpose Using the example of community access programs (CAPs), the purpose of this paper is to describe resource allocation and policy decisions related to providing health services for the uninsured in the USA and the organizational values affecting these decisions. Design/methodology/approach The study used comparative case study methodology at two geographically diverse sites. Researchers collected data from program documents, meeting observations, and interviews with program stakeholders. Findings Five resource allocation or policy decisions relevant to providing healthcare services were described at each site across three categories: designing the health plan, reacting to funding changes, and revising policies. Organizational values of access to care and stewardship most frequently affected resource allocation and policy decisions, while economic and political pressures affect the relative prioritization of values. Research limitations/implications Small sample size, the potential for social desirability or recall bias, and the exclusion of provider, member or community perspectives beyond those represented among participating board members. Practical implications Program directors or researchers can use this study to assess the extent to which resource allocation and policy decisions align with organizational values and mission statements. Social implications The description of how healthcare decisions are actually made can be matched with literature that describes how healthcare resource decisions ought to be made, in order to provide a normative grounding for future decisions. Originality/value This study addresses a gap in literature regarding how CAPs actually make resource allocation decisions that affect access to healthcare services.
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Affiliation(s)
- Krista Lyn Harrison
- Division of Geriatrics, University of California , San Francisco, California, USA
- San Francisco VA Medical Center, San Francisco, California, USA
| | - Holly A Taylor
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Berman Institute of Bioethics, Johns Hopkins University , Baltimore, Maryland, USA
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Harrison KL, Taylor HA. Organizational values in the provision of access to care for the uninsured. AJOB Empir Bioeth 2016; 7:240-250. [PMID: 28781981 DOI: 10.1080/23294515.2016.1170075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND For the last 20 years, health provider organizations have made efforts to align mission, values, and everyday practices to ensure high-quality, high-value, and ethical care. However, little attention has been paid to the organizational values and practices of community-based programs that organize and facilitate access to care for uninsured populations. This study aimed to identify and describe organizational values relevant to resource allocation and policy decisions that affect the services offered to members, using the case of community access programs: county-based programs that provide access to care for the uninsured working poor. METHODS Comparative and qualitative case study methodology was used, including document review, observations, and key informant interviews, at two geographically diverse programs. RESULTS Nine values were identified as relevant to decision making: stewardship, quality care, access to care, service to others, community well-being, member independence, organizational excellence, decency, and fairness. The way these values were deployed in resource allocation decisions that affected services offered to the uninsured are illustrated in one example per site. CONCLUSIONS This study addresses the previous dearth in the literature regarding an empirical description of organizational values employed in decision making of community organizations. To assess the transferability of the values identified, we compared our empirical results to prior empirical and conceptual work in the United States and internationally and found substantial alignment. Future studies can examine whether the identified organizational values are reflective of those at other health care organizations.
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Affiliation(s)
| | - Holly A Taylor
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, and Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University
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Agee MD, Gates Z, Reilly P. Cost-Effectiveness of a Low-Cost, Hospital-Based Primary Care Clinic. Health Serv Res Manag Epidemiol 2014; 1:2333392814557011. [PMID: 28462248 PMCID: PMC5289068 DOI: 10.1177/2333392814557011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study assesses the cost-effectiveness of an insurance administration-free, hospital-based clinic designed to provide a full array of primary care services to low-income individuals at little or no cost. In addition to low/no-cost visits, individuals have the option to purchase a low-cost health insurance plan similar to any traditional health plan (eg, prescriptions, primary care, specialty care, durable medical equipment, radiology, laboratory test results). We used 3 years of data (2009-2012) on emergency department (ED) visits and inpatient hospital admissions from clinic patients and patients at the community's 2 largest private physician groups to assess the cost-effectiveness of the hospital-based clinic in terms of ED and inpatient admission costs avoided and financial sustainability of the low-cost insurance plan. Estimated annual savings in hospital inpatient and ED costs were approximately 1.4 million. Insurance plan data indicated sound fiscal sustainability with modest provider reimbursement growth and zero annual premium growth.
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Affiliation(s)
- Mark D Agee
- Department of Economics, Pennsylvania State University, Altoona, PA, USA
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Fried B, Pintor JK, Graven P, Blewett LA. Implementing federal health reform in the States: who is included and excluded and what are their characteristics? Health Serv Res 2014; 49 Suppl 2:2062-85. [PMID: 25255892 DOI: 10.1111/1475-6773.12232] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To estimate the characteristics and number of nonelderly adults eligible and ineligible for Affordable Care Act (ACA) expansions. DATA SOURCES AND SETTINGS Two secondary data sources are used in this analysis: the 2008 Panel of the Survey of Income and Program Participation (SIPP) and the 2009 American Community Survey (ACS). STUDY DESIGN We use multiple imputation to incorporate model-based uncertainty into the prediction of immigration status into the ACS from the SIPP. Key variables include place of birth, year of entry to the U.S., and health insurance coverage. DATA COLLECTION/EXTRACTING METHODS No primary data are used in this study. PRINCIPLE FINDINGS We estimate that potentially 3.5 million nonelderly adults will be excluded from the ACA Medicaid Expansion and 2 million from the health insurance exchanges because of their immigration status. We also find significant differences in estimates of excluded nonelderly adults across states. CONCLUSIONS Over 15 percent of income-eligible uninsured nonelderly adults will be potentially excluded from the ACA coverage expansions due to their immigration status. Policy makers must be careful to exclude ineligible nonelderly adults before estimating the impact of the ACA on coverage rates.
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Affiliation(s)
- Brett Fried
- State Health Access Data Assistance Center, University of Minnesota, Minneapolis, MN
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Breton M, Brousselle A, Boivin A, Loignon C, Touati N, Dubois CA, Nour K, Berbiche D, Roberge D. Evaluation of the implementation of centralized waiting lists for patients without a family physician and their effects across the province of Quebec. Implement Sci 2014; 9:117. [PMID: 25185703 PMCID: PMC4159553 DOI: 10.1186/s13012-014-0117-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 08/25/2014] [Indexed: 12/05/2022] Open
Abstract
Background Most national and provincial commissions on healthcare services in Canada over the past decade have recommended that primary care services be strengthened in order to guarantee each citizen access to a family physician. Despite these recommendations, finding a family physician continues to be problematic. The issue of enrolment with a family physician is worrying in Canada, where nearly 21% of the country's population reported not having a family physician in the last Commonwealth Fund survey. To respond to this important need, centralized waiting lists have been implemented in four Canadian provinces to help `orphan,' or unaffiliated, patients find a family physician. These organizational mechanisms are intended to better coordinate the demand for and supply of family physicians. The objectives of this study are: to assess the effects of centralized waiting lists for orphan patients (GACOs) implemented in the province of Quebec and to explain the variation among their effects by analyzing factors influencing implementation process. Methods This study is based on two complementary and sequential research strategies. The first (objective 1) is a quantitative longitudinal design to assess the effects of all the GACOs (n = 93) in Quebec using clinical-administrative data. The second (objective 2) involves using four case studies to explain variations in effects through in-depth analysis of the various factors contributing to the observed effects. The primary source of data will be key actors involved in the GACOs. We expect to conduct around 40 semi-structured interviews. Discussion This will be the first study in Canada to evaluate the implementation of this innovation. It will provide an exhaustive picture of the effects of GACO implementation in Quebec and to assess their potential for generalization elsewhere in Canada. At the theoretical level, this study will produce new knowledge on the factors having the greatest influence on the implementation of primary care innovations in professional environments. Electronic supplementary material The online version of this article (doi:10.1186/s13012-014-0117-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mylaine Breton
- Charles-LeMoyne Hospital Research Centre, Greenfield Park J4K 0A8, QC, Canada.
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Local access to care programs increase trauma patient follow-up compliance. Am J Surg 2014; 208:476-9. [DOI: 10.1016/j.amjsurg.2013.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/22/2013] [Accepted: 11/22/2013] [Indexed: 11/19/2022]
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Feinglass J, Nonzee NJ, Murphy KR, Endress R, Simon MA. Access to care outcomes: a telephone interview study of a suburban safety net program for the uninsured. J Community Health 2014; 39:108-17. [PMID: 24026301 PMCID: PMC3947220 DOI: 10.1007/s10900-013-9746-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Access DuPage (AD) currently provides primary care for about 14,000 low income, uninsured residents of suburban DuPage County, IL, an area with a very limited healthcare safety net infrastructure. A telephone interview survey evaluated health care utilization, satisfaction, and health status outcomes and compared recent enrollees to individuals in the program for at least 1 year. Sequential new AD enrollees (n = 158) were asked about the previous year when uninsured, while randomly selected established AD enrollees (n = 135) were asked the same questions about the previous year when actively enrolled in AD. Established enrollees reported being more likely to get 'any kind of tests or treatment' (96.3 vs. 46.2 %, p < 0.0001), fewer cost (78.5 vs. 21.3 %, p < 0.0001) and transportation barriers to care, more preventive and mental health services, and better self-management care. However, established enrollees also reported 14 % greater use of hospital inpatient and 9 % greater use of emergency room care, as well as continued difficulty in accessing needed specialty and dental care services. Despite more (diagnosed) conditions, established enrollees were over 2.5 times more likely to report good to excellent health status and over three times more likely to rate their satisfaction with health care as good to excellent. Findings illustrate the substantial benefits of assuring access to care for the uninsured, but do not reflect immediate savings from reduced hospital utilization. Access to care programs will be an important tool to address the needs of the 30 million people who will continue to be uninsured in the United States.
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Affiliation(s)
- Joe Feinglass
- Department of Medicine, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL, 60611, USA,
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Mackinney T, Visotcky AM, Tarima S, Whittle J. Does providing care for uninsured patients decrease emergency room visits and hospitalizations? J Prim Care Community Health 2013; 4:135-42. [PMID: 23799722 DOI: 10.1177/2150131913478981] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Access to primary care could reduce use of more costly health care by uninsured individuals through prevention and early treatment. We analyzed data from a program providing free primary care to test this hypothesis. METHODS We compared emergency room (ER) visits and hospitalizations among uninsured, low-income adults who received immediate versus delayed access to a program providing free primary care, including labs, X-rays, and specialty consultation. We used surveys to identify ER visits and hospitalizations during the 12 months preceding and following program enrollment or wait list entry. RESULTS Hospitalizations decreased from the year before entry to the year following entry in participants with immediate and delayed (6.0% vs 8.8% decrease) access. ER use also decreased in both groups (11.2% vs 15.4%). CONCLUSIONS Free primary care services and specialty consultation did not reduce use of more costly health care services during its first year. More prolonged availability of primary care might have greater impact.
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Affiliation(s)
- Ted Mackinney
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Cunningham P, Felland L, Stark L. Safety-net providers in some US communities have increasingly embraced coordinated care models. Health Aff (Millwood) 2013; 31:1698-707. [PMID: 22869647 DOI: 10.1377/hlthaff.2011.1270] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Safety-net organizations, which provide health services to uninsured and low-income people, increasingly are looking for ways to coordinate services among providers to improve access to and quality of care and to reduce costs. In this analysis, a part of the Community Tracking Study, we examined trends in safety-net coordination activities from 2000 to 2010 within twelve communities in the United States and found a notable increase in such activities. Six of the twelve communities had made formal efforts to link uninsured people to medical homes and coordinate care with specialists in 2010, compared to only two communities in 2000. We also identified key attributes of safety-net coordinated care systems, such as reliance on a medical home for meeting patients' primary care needs, and lingering challenges to safety-net integration, such as competition among hospitals and community health centers for Medicaid patients.
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Affiliation(s)
- Peter Cunningham
- Center for Studying Health System Change in Washington, DC, USA.
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Improvements in Health Behaviors and Health Status Among Newly Insured Members of an Innovative Health Access Plan. J Community Health 2012; 38:301-9. [DOI: 10.1007/s10900-012-9615-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Do diabetic patients living in racially segregated neighborhoods experience different access and quality of care? Med Care 2012; 50:692-9. [PMID: 22525608 DOI: 10.1097/mlr.0b013e318254a43c] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Place of residence, particularly residential segregation, has been implicated in health and health care disparities. However, prior studies have not focused on care for diabetes, a prevalent condition for minority populations. OBJECTIVE To examine the association of residential segregation with a range of access and quality of care outcomes among black and Hispanics with diabetes using a nationally representative US sample. RESEARCH DESIGN Cross-sectional study using data for 1598 adult patients with diabetes from the 2006 Medical Expenditure Panel Survey linked to residential segregation information for blacks and Hispanics on the basis of the 2000 census. Relationships of 5 dimensions of residential segregation (dissimilarity, isolation, clustering, concentration, and centralization) with access and quality of care outcomes were examined using linear, logistic, and multinomial logistic regression models, controlling for respondent characteristics and community utilization and hospital capacity. RESULTS Black and Hispanics with diabetes had comparable or better access to providers, but received fewer recommended services. Living in a segregated community was associated with more recommended services received, but also problems with seeing a specialist. The relationship of residential segregation to diabetes care varied depending on type of segregation and race/ethnic group assessed. CONCLUSIONS Residential segregation influences the care experience of patients with diabetes in the United States. Our study highlights the importance of investigating how different types of segregation may affect diabetes care received by patients from different race and ethnic groups.
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Felland LE, Ginsburg PB, Kishbauch GM. Improving health care access for low-income people: lessons from ascension health's community collaboratives. Health Aff (Millwood) 2011; 30:1290-8. [PMID: 21734203 DOI: 10.1377/hlthaff.2010.1115] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Communities across the nation are struggling with how to improve access to health care for low-income people. We examined seven communities where Ascension Health collaborated with other safety-net providers and organizations to achieve better health care results for patients. Following a five-step model, each community established infrastructure to track the use of services, expand service capacity, coordinate care, and encourage the cost-effective use of providers. These efforts have achieved notable gains, such as in Austin, Texas, where an estimated $5.50 was returned for every dollar spent on asthma care. Challenges remain, including provider competition, inadequate participation by clinicians, difficulties demonstrating impact, and lack of sustainable funding. Lessons gleaned from these community collaborations can be valuable as the nation implements health reform, and safety-net health care systems home in on remaining access issues.
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Spatz ES, Phipps MS, Wang OJ, Lagarde S, Lucas GI, Curry LA, Rosenthal MS. Expanding the safety net of specialty care for the uninsured: a case study. Health Serv Res 2011; 47:344-62. [PMID: 22092239 DOI: 10.1111/j.1475-6773.2011.01330.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To describe core principles and processes in the implementation of a navigated care program to improve specialty care access for the uninsured. STUDY SETTING Academic researchers, safety-net providers, and specialty physicians, partnered with hospitals and advocates for the underserved to establish Project Access-New Haven (PA-NH). PA-NH expands access to specialty care for the uninsured and coordinates care through patient navigation. STUDY DESIGN Case study to describe elements of implementation that may be relevant for other communities seeking to improve access for vulnerable populations. PRINCIPAL FINDINGS Implementation relied on the application of core principles from community-based participatory research (CBPR). Effective partnerships were achieved by involving all stakeholders and by addressing barriers in each phase of development, including (1) assessment of the problem; (2) development of goals; (3) engagement of key stakeholders; (4) establishment of the research agenda; and (5) dissemination of research findings. CONCLUSIONS Including safety-net providers, specialty physicians, hospitals, and community stakeholders in all steps of development allowed us to respond to potential barriers and implement a navigated care model for the uninsured. This process, whereby we integrated principles from CBPR, may be relevant for future capacity-building efforts to accommodate the specialty care needs of other vulnerable populations.
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Affiliation(s)
- Erica S Spatz
- Robert Wood Johnson Foundation Clinical Scholars Program, Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
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Hall MA. Getting to universal coverage with better safety-net programs for the uninsured. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2011; 36:521-526. [PMID: 21673257 DOI: 10.1215/03616878-1271198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Rajabiun S, Bachman SS, Fox JE, Tobias C, Bednarsh H. A typology of models for expanding access to oral health care for people living with HIV/AIDS. J Public Health Dent 2011. [DOI: 10.1111/j.1752-7325.2011.00249.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hall MA. Access to care provided by better safety net systems for the uninsured: measuring and conceptualizing adequacy. Med Care Res Rev 2011; 68:441-61. [PMID: 21536602 DOI: 10.1177/1077558710394201] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This descriptive study assesses the access to care provided by five model and diverse safety net programs that enroll uninsured adults in a coordinated system offering primary care, hospital care, prescription drugs, and most specialist services. Physician use by safety net program members was similar to insured groups. However, there was less use of hospitals in the two programs that relied on uncompensated charity care. Considering access measures commonly used in population-based surveys, the uninsured in these five communities fared no better than uninsured elsewhere. However, respondents may consider enrollment in a well-structured safety net program to be equivalent to insurance. If so, population surveys may be least accurate in identifying uninsured people in the very communities that have the best safety net programs. On balance the five safety net systems profiled here meet the needs of low-income uninsured residents at a level that is roughly similar to that for people with insurance.
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Affiliation(s)
- Mark A Hall
- Wake Forest University, Winston-Salem, NC, USA.
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Abstract
OBJECTIVE We sought to determine which demographic and practice characteristics are associated with both a surgeon's willingness to provide any charity care as well as the amount of charity care provided. BACKGROUND Although it is known that surgeons tend to provide a greater amount of charity care than other physicians, no studies have attempted to look within the surgeon population to identify which factors lead some surgeons to provide more charity care than others. METHODS Using 4 rounds of data from the Community Tracking Study, we employ a 2-part multivariate regression model with fixed effects. RESULTS A greater amount of charity care is provided by surgeons who are male, practice owners, employed in academic medical centers, or earn a greater proportion of their revenue from Medicaid. Surgeons who work in a group HMO are significantly less likely to provide any charity care. Personal resources (eg, time and money) had a minimal association with charity care provision. CONCLUSIONS Surgeons whose characteristics are associated with a greater propensity for charity care provision as suggested by this study, should be considered as a potential source for building the volunteer workforce.
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