1
|
Schippers MC, Ioannidis JPA, Luijks MWJ. Is society caught up in a Death Spiral? Modeling societal demise and its reversal. FRONTIERS IN SOCIOLOGY 2024; 9:1194597. [PMID: 38533441 PMCID: PMC10964949 DOI: 10.3389/fsoc.2024.1194597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 02/19/2024] [Indexed: 03/28/2024]
Abstract
Just like an army of ants caught in an ant mill, individuals, groups and even whole societies are sometimes caught up in a Death Spiral, a vicious cycle of self-reinforcing dysfunctional behavior characterized by continuous flawed decision making, myopic single-minded focus on one (set of) solution(s), denial, distrust, micromanagement, dogmatic thinking and learned helplessness. We propose the term Death Spiral Effect to describe this difficult-to-break downward spiral of societal decline. Specifically, in the current theory-building review we aim to: (a) more clearly define and describe the Death Spiral Effect; (b) model the downward spiral of societal decline as well as an upward spiral; (c) describe how and why individuals, groups and even society at large might be caught up in a Death Spiral; and (d) offer a positive way forward in terms of evidence-based solutions to escape the Death Spiral Effect. Management theory hints on the occurrence of this phenomenon and offers turn-around leadership as solution. On a societal level strengthening of democracy may be important. Prior research indicates that historically, two key factors trigger this type of societal decline: rising inequalities creating an upper layer of elites and a lower layer of masses; and dwindling (access to) resources. Historical key markers of societal decline are a steep increase in inequalities, government overreach, over-integration (interdependencies in networks) and a rapidly decreasing trust in institutions and resulting collapse of legitimacy. Important issues that we aim to shed light on are the behavioral underpinnings of decline, as well as the question if and how societal decline can be reversed. We explore the extension of these theories from the company/organization level to the society level, and make use of insights from both micro-, meso-, and macro-level theories (e.g., Complex Adaptive Systems and collapsology, the study of the risks of collapse of industrial civilization) to explain this process of societal demise. Our review furthermore draws on theories such as Social Safety Theory, Conservation of Resources Theory, and management theories that describe the decline and fall of groups, companies and societies, as well as offer ways to reverse this trend.
Collapse
Affiliation(s)
- Michaéla C. Schippers
- Department of Organisation and Personnel Management, Rotterdam School of Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - John P. A. Ioannidis
- Department of Medicine, Stanford University, Stanford, CA, United States
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, United States
- Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
- Department of Statistics, Stanford University, Stanford, CA, United States
- Meta-Research Innovation Center at Stanford, Stanford University, Stanford, CA, United States
| | - Matthias W. J. Luijks
- Department of History of Philosophy, Faculty of Philosophy, University of Groningen, Groningen, Netherlands
| |
Collapse
|
2
|
Peano A, Politano G, Gianino MM. Determinants of COVID-19 vaccination worldwide: WORLDCOV, a retrospective observational study. Front Public Health 2023; 11:1128612. [PMID: 37719735 PMCID: PMC10501313 DOI: 10.3389/fpubh.2023.1128612] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/19/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction The COVID-19 pandemic has resulted in numerous deaths, great suffering, and significant changes in people's lives worldwide. The introduction of the vaccines was a light in the darkness, but after 18 months, a great disparity in vaccination coverage between countries has been observed. As disparities in vaccination coverage have become a global public health issue, this study aimed to analyze several variables to identify possible determinants of COVID-19 vaccination. Methods An ecological study was conducted using pooled secondary data sourced from institutional sites. A total of 205 countries and territories worldwide were included. A total of 16 variables from different fields were considered to establish possible determinants of COVID-19 vaccination: sociodemographic, cultural, infrastructural, economic and political variables, and health system performance indicators. The percentage of the population vaccinated with at least one dose and the total doses administered per 100 residents on 15 June 2022 were identified as indicators of vaccine coverage and outcomes. Raw and adjusted values for delivered vaccine doses in the multivariate GLM were determined using R. The tested hypothesis (i.e., variables as determinants of COVID-19 vaccination) was formulated before data collection. The study protocol was registered with the grant number NCT05471635. Results GDP per capita [odds = 1.401 (1.299-1.511) CI 95%], access to electricity [odds = 1.625 (1.559-1.694) CI 95%], political stability, absence of violence/terrorism [odds = 1.334 (1.284-1.387) CI 95%], and civil liberties [odds = 0.888 (0.863-0.914) CI 95%] were strong determinants of COVID-19 vaccination. Several other variables displayed a statistically significant association with outcomes, although the associations were stronger for total doses administered per 100 residents. There was a substantial overlap between raw outcomes and their adjusted counterparts. Discussion This pioneering study is the first to analyze the association between several different categories of indicators and COVID-19 vaccination coverage in a wide complex setting, identifying strong determinants of vaccination coverage. Political decision-makers should consider these findings when organizing mass vaccination campaigns in a pandemic context to reduce inequalities between nations and to achieve a common good from a public health perspective.
Collapse
Affiliation(s)
- Alberto Peano
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
| | - Gianfranco Politano
- Department of Control and Computer Engineering, Polytechnic of Turin, Turin, Italy
| | - Maria Michela Gianino
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
| |
Collapse
|
3
|
McClintock HF, Edmonds SE, Bogner HR. Depression and Cost-Related Health Care Utilization Among Persons with Diabetes. Popul Health Manag 2023; 26:232-238. [PMID: 37590079 DOI: 10.1089/pop.2023.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
The presence of depression among people with diabetes can substantially increase health care costs and reduce health care utilization. This study aimed at further elucidating the factors underlying the relationship between depressive disorders and health care utilization among people with diabetes. Data were obtained from the 2019 Behavioral Risk Factor Surveillance System, and the sample was limited to people with diabetes (n = 22,642). The independent variable was assessed by a lifetime diagnosis of depressive disorder, including depression, major depression, dysthymia, or minor depression. The dependent variable was cost-related health care utilization assessed as a response (yes/no) to whether participants had not seen a doctor due to costs in the past year. Logistic regression models examined the association between depressive disorders and health care utilization, adjusting for covariates incorporating weighting to account for study design. Overall, 25.2% of the people with diabetes reported having had a depressive disorder in their lifetime. People with diabetes who had ever been diagnosed with a depressive disorder were more likely to have reported not seeing a doctor due to costs in the past year (adjusted odds ratio: 1.82 [1.49, 2.28]). Findings from this study suggest a need for further research regarding the relationship between depression and cost-related health care utilization among people with diabetes.
Collapse
Affiliation(s)
- Heather F McClintock
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, Pennsylvania, USA
| | - Sarah E Edmonds
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, Pennsylvania, USA
| | - Hillary R Bogner
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
4
|
Ahuja M, Cimilluca J, Stamey J, Doshi RP, Wani RJ, Al-Ksir K, Adebayo-Abikoye EE, Karki A, Annor EN, Nwaneki CM. Association between Financial Barriers to Healthcare Access and Mental Health Outcomes in Tennessee. South Med J 2023; 116:176-180. [PMID: 36724532 DOI: 10.14423/smj.0000000000001512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES A large number of people cannot afford healthcare services in the United States. Researchers have studied the impact of lack of affordability of health care on the outcomes of various physical conditions. Mental health disorders have emerged as a major public health challenge during the past decade. The lack of affordability of health care also may contribute to the burden of mental health. This research focuses on the association between financial barriers to health care and mental health outcomes in the US state of Tennessee. METHODS We used cross-sectional data contained in the 2019 US Behavioral Risk Factor Surveillance System (BRFSS). We extracted data for the state of Tennessee, which included 6242 adults aged 18 years or older. Multinomial regression analyses were conducted to test the association between not being able to see a doctor with the number of mentally unhealthy days during the past month. We coded the outcome as a three-level variable, ≥20 past-month mentally unhealthy days, 1 to 20 past-month mentally unhealthy days, and 0 past-month mentally unhealthy days. The covariates examined included self-reported alcohol use, self-reported marijuana use, and other demographic variables. RESULTS Overall, 11.0% of participants reported ≥20 past-month mentally unhealthy days and 24.0% reported 1 to 20 past-month mentally unhealthy days. More than 13% of study participants reported they could not see a doctor because of the cost in the past 12 months. The inability to see a doctor because of the cost of care was associated with a higher risk of ≥20 past-month mentally unhealthy days (relative risk ratio 3.18; 95% confidence interval 2.57-3.92, P < 0.001) and 1 to 19 past-month mentally unhealthy days (relative risk ratio 1.94; 95% confidence interval 1.63-2.32, P < 0.001). CONCLUSIONS Statistically significant associations were observed between the inability to see a doctor when needed because of cost and increased days of poorer mental health outcomes. This research has potential policy implications in the postcoronavirus disease 2019 era with healthcare transformation and significant financial impact.
Collapse
Affiliation(s)
- Manik Ahuja
- From the College of Public Health, East Tennessee State University, Johnson City
| | - Johanna Cimilluca
- From the College of Public Health, East Tennessee State University, Johnson City
| | - Jessica Stamey
- the College of Nursing, East Tennessee State University, Johnson City
| | - Riddhi P Doshi
- the Center for Population Health, University of Connecticut, Farmington
| | - Rajvi J Wani
- the University of Nebraska Medical Center, Omaha
| | - Kawther Al-Ksir
- From the College of Public Health, East Tennessee State University, Johnson City
| | | | - Aparna Karki
- From the College of Public Health, East Tennessee State University, Johnson City
| | - Eugene N Annor
- From the College of Public Health, East Tennessee State University, Johnson City
| | - Chisom M Nwaneki
- From the College of Public Health, East Tennessee State University, Johnson City
| |
Collapse
|
5
|
Gao J, Moran E, Grimm R, Toporek A, Ruser C. The Effect of Primary Care Visits on Total Patient Care Cost: Evidence From the Veterans Health Administration. J Prim Care Community Health 2022; 13:21501319221141792. [PMID: 36564889 PMCID: PMC9793026 DOI: 10.1177/21501319221141792] [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: 12/25/2022] Open
Abstract
BACKGROUND Since the 1980s, primary care (PC) in the US has been recognized as the backbone of healthcare providing comprehensive care to complex patients, coordinating care among specialists, and rendering preventive services to contain costs and improve clinical outcomes. However, the effect of PC visits on total patient care cost has been difficult to quantify. OBJECTIVE To assess the effect of PC visits on total patient care cost. METHODS This is a retrospective study of over 5 million patients assigned to a PC provider in the Veterans Health Administration (VHA) in each of the 4 fiscal years (FY 2016-2019). The main outcome of interest is total annual patient care cost. We assessed the effect of primary care visits on total patient care cost first by descriptive statistics, and then by multivariate regressions adjusting for severity of illness and other confounders. We conducted in-depth sensitivity analyses to validate the findings. RESULTS On average, each additional in-person PC visit was associated with a total cost reduction of $721 (per patient per year). The first PC visit was associated with the largest savings, $3976 on average, and a steady diminishing return was observed. Further, the higher the patient risk (severity of illness), the larger the cost reduction: Among the top 10% of high-risk patients, the first PC in-person visit was associated with a reduction of $16 406 (19%). CONCLUSIONS These findings, substantiated by our exhaustive sensitivity analyses, suggest that expanding PC capacity can significantly reduce overall health care costs and improve patient care outcomes given the former is a strong proxy of the latter.
Collapse
Affiliation(s)
- Jian Gao
- Department of Veterans Affairs, Office
of Productivity, Efficiency and Staffing (OPES), Office of Analytics and Performance
Improvement,Jian Gao, Department of Veterans Affairs,
Office of Productivity, Efficiency and Staffing, Office of Analytics and
Performance Improvement, 67 Veterans Way, Albany, NY 12208, USA.
| | - Eileen Moran
- Department of Veterans Affairs, Office
of Productivity, Efficiency and Staffing (OPES), Office of Analytics and Performance
Improvement
| | | | - Andrew Toporek
- Department of Veterans Affairs, Office
of Productivity, Efficiency and Staffing (OPES), Office of Analytics and Performance
Improvement
| | - Christopher Ruser
- VACT Healthcare System, Yale University
School of Medicine, New Haven, CT, USA
| |
Collapse
|
6
|
Tarricone A, Gee A, De La Mata K, Primavera L, Trepal M, Axman W, Perake V, Krishnan P. Health Disparities in Non-Traumatic Lower Extremity Amputations. A Systematic Review and Meta-Analysis. Ann Vasc Surg 2022; 88:410-417. [DOI: 10.1016/j.avsg.2022.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022]
|
7
|
Ahmed R, Shadis A, Ahmed R. Potential inflammatory biomarkers for tinnitus in platelets and leukocytes: a critical scoping review and meta-analysis. Int J Audiol 2022; 61:905-916. [PMID: 34978520 DOI: 10.1080/14992027.2021.2018511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To explore the association between platelets or leukocytes and tinnitus. DESIGN A meta-analysis and scoping review examining the association between tinnitus and platelets and leukocytes. All 11 studies included were critically appraised using the Joanna Briggs Institute (JBI) checklist (2017a). A random effects model was used to pool the results of the studies examining mean platelet volume (MPV) and tinnitus. STUDY SAMPLE 1935 studies were identified in the initial search, 11 of which were included in the scoping review. 6 of the 11 studies had their MPV values pooled in the meta-analysis. RESULTS Pooled results of 818 subjects from 6 studies indicated that MPV was significantly higher in those with tinnitus compared to a comparison group without tinnitus. The overall mean difference was 0.43 fL with a 95% confidence interval (CI) from 0.31 to 0.55 and a p value of < 0.0001 which was statistically significant. MPV is the only haematological parameter which is reliably associated with tinnitus. CONCLUSIONS MPV could be a useful biomarker for tinnitus. Further studies should aim to standardise methodology with more rigorous exclusion criteria to reproduce and define this association. NLR, PLR, WBC count, RDW and PDW do not show a reliable association with tinnitus.
Collapse
Affiliation(s)
- Raheel Ahmed
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Alice Shadis
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Rumana Ahmed
- Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| |
Collapse
|
8
|
Madden JM, Bayapureddy S, Briesacher BA, Zhang F, Ross-Degnan D, Soumerai SB, Gurwitz JH, Galbraith AA. Affordability of Medical Care Among Medicare Enrollees. JAMA HEALTH FORUM 2021; 2:e214104. [PMID: 35977305 PMCID: PMC8796945 DOI: 10.1001/jamahealthforum.2021.4104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022] Open
Abstract
Importance Cost-sharing requirements can discourage patients from seeking care and impose financial hardship. The Medicare program serves many older and disabled individuals with multimorbidity and limited resources, but little has been known about the affordability of care in this population. Objective To examine the affordability of medical care among Medicare enrollees, in terms of the prevalence of delaying medical care because of costs and having problems paying medical bills, and risk factors for these outcomes. Design Setting and Participants Cross-sectional analyses conducted from November 1, 2019, to October 15, 2021, used logistic regression to compare the probability of outcomes by demographic and health characteristics. Data were obtained from the 2017 nationally representative Medicare Current Beneficiary Survey (response rate, 61.7%), with respondents representing 53 million community-dwelling Medicare enrollees. Main Outcomes and Measures New questions about medical care affordability were included in the 2017 Medicare Current Beneficiary Survey: difficulty paying medical bills, ongoing medical debt, and contact by collection agencies. A companion survey question asked whether individuals had delayed seeking medical care because of worries about costs. Results Respondents included 10 974 adults aged 65 years or older and 2197 aged 18 to 64 years; 54.2% of all respondents were women. The weighted proportions of Medicare enrollees with annual incomes below $25 000K were 30.7% in the older population and 67.4% in the younger group. Self-reported prevalence of delaying care because of cost was 8.3% (95% CI, 7.4%-9.1%) among enrollees aged 65 years or older, 25.2% (95% CI, 21.8%-28.6%) among enrollees younger than 65 years, and 10.9% (95% CI, 9.9%-11.9%) overall. Similarly, 7.4% (95% CI, 6.6%-8.2%) of older enrollees had problems paying medical bills, compared with 29.8% (95% CI, 25.6%-34.1%) among those younger than 65 years and 10.8% (95% CI, 9.8%-11.9%) overall. Regarding specific payment problems, 7.9% (95% CI, 7.0%-8.9%) of enrollees overall experienced ongoing medical debt, contact by a collection agency, or both. In adjusted analyses, older adults with incomes $15 000 to $25 000 per year had odds of delaying care more than twice as high as those with incomes greater than $50 000 (odds ratio, 2.47; 95% CI, 1.82-3.39), and their odds of problems paying medical bills were more than 3 times as high (odds ratio, 3.37; 95% CI, 2.81-5.21). Older adults with 4 to 10 chronic conditions were more than twice as likely to have problems paying medical bills as those with 0 or 1 condition. Conclusions and Relevance The findings of this study suggest that unaffordability of medical care is common among Medicare enrollees, especially those with lower incomes, or worse health, or who qualify for Medicare based on disability. Policy reforms, such as caps on patient spending, are needed to reduce Medical cost burdens on the most vulnerable enrollees.
Collapse
Affiliation(s)
- Jeanne M. Madden
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy and Pharmaceutical Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care, Boston, Massachusetts
| | - Susmitha Bayapureddy
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy and Pharmaceutical Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Becky A. Briesacher
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy and Pharmaceutical Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Fang Zhang
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care, Boston, Massachusetts
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care, Boston, Massachusetts
| | - Stephen B. Soumerai
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care, Boston, Massachusetts
| | - Jerry H. Gurwitz
- Meyers Primary Care Institute, Worcester, Massachusetts
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
| | - Alison A. Galbraith
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care, Boston, Massachusetts
| |
Collapse
|
9
|
Paturzo JGR, Hashim F, Dun C, Boctor MJ, Bruhn WE, Walsh C, Bai G, Makary MA. Trends in Hospital Lawsuits Filed Against Patients for Unpaid Bills Following Published Research About This Activity. JAMA Netw Open 2021; 4:e2121926. [PMID: 34424301 PMCID: PMC8383135 DOI: 10.1001/jamanetworkopen.2021.21926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE Suing patients and garnishing their wages for unpaid medical bills can be a predatory form of financial activity that may be inconsistent with the mission of a hospital. Many hospitals in the state of Virginia were discovered to be suing patients for unpaid medical bills, as first presented in a 2019 research article that launched 2.5 months of media attention on hospital billing practices and a grassroots public demand for hospitals to stop the practice. OBJECTIVE To evaluate the association of a research publication and subsequent media coverage with the number of hospital lawsuits filed against patients for unpaid medical bills. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of Virginia hospitals that sued patients for unpaid medical bills used an interrupted time series analysis. Data on hospitals suing patients for unpaid medical bills were collected during a preintervention period (June 25, 2018, to June 24, 2019), an intervention period (June 25, 2019, to September 10, 2019), and a postintervention period (September 11, 2019, to September 10, 2020). EXPOSURES Publication of a research article and subsequent media coverage. MAIN OUTCOMES AND MEASURES The total number of warrant in debt and wage garnishment lawsuits filed by Virginia hospitals and the frequency of those lawsuits filed before, during, and after the intervention period on a weekly basis. RESULTS A total of 50 387 lawsuits, filed by 67 Virginia hospitals, were included; 33 204 (65.9%) were warrant in debt lawsuits, and 17 183 (34.1%) were wage garnishment lawsuits. From the preintervention period to the postintervention period, there was a 59% decrease in the number of lawsuits filed (from 30 760 lawsuits to 12 510 lawsuits), a 55% decrease in the number of warrant in debt cases filed (from 19 329 to 8651), a 66% decrease in the number of wage garnishments filed (from 11 431 to 3859), and a 64% decrease in the dollar amount pursued in court (from $38 700 209 to $13 960 300). During the study period, 11 hospitals banned the practice of suing patients for unpaid medical bills. The interrupted time series analysis showed a significant decrease of 5% (incidence rate ratio, 0.95; 95% CI, 0.94-0.96) in the total weekly number of lawsuits in the postintervention period. CONCLUSIONS AND RELEVANCE The findings of this study suggest that research leading to public awareness can shift hospital billing practices.
Collapse
Affiliation(s)
| | - Farah Hashim
- The Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Chen Dun
- The Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Michael J. Boctor
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Christi Walsh
- The Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Ge Bai
- The Johns Hopkins Carey Business School, Johns Hopkins University, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Martin A. Makary
- The Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland
- The Johns Hopkins Carey Business School, Johns Hopkins University, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
10
|
Pearls for Managing Atopic Dermatitis in Patients With Low Socioeconomic Status. Dermatitis 2021; 31:297-302. [PMID: 32947458 DOI: 10.1097/der.0000000000000634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory dermatosis presenting with inflamed and itchy skin. Recent studies have shown an inverse relationship between socioeconomic status and the severity of AD. Low socioeconomic status (LSES) individuals with AD face specific barriers that may impede management. These include forgoing doctor's appointments due to transportation costs, inability to take time off from work, and lack of affordable childcare services. Unaffordable medications and over-the-counter products for managing AD further present as significant challenges for LSES patients. This article aims to offer practical and affordable recommendations to help mitigate the challenges faced by LSES patients with AD and thereby alleviate disease burden and improve treatment outcomes.
Collapse
|
11
|
Olsen DP, Keilman LJ. The Moral Distress of Nurses When Patients Forgo Treatment Because of Cost. Am J Nurs 2020; 120:61-66. [PMID: 32858703 DOI: 10.1097/01.naj.0000697668.09031.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nursing must recognize an ethical obligation to respond on behalf of these patients.
Collapse
Affiliation(s)
- Douglas P Olsen
- Douglas P. Olsen and Linda J. Keilman, a gerontological NP, are associate professors at the Michigan State University College of Nursing in East Lansing. Olsen is a contributing editor of AJN. Contact author: Douglas P. Olsen, . The authors have disclosed no potential conflicts of interest, financial or otherwise. A podcast with the authors is available at www.ajnonline.com
| | | |
Collapse
|
12
|
Ward A, Clark J, McLeod J, Woodul R, Moser H, Konrad C. The impact of heat exposure on reduced gestational age in pregnant women in North Carolina, 2011-2015. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2019; 63:1611-1620. [PMID: 31367892 DOI: 10.1007/s00484-019-01773-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 07/06/2019] [Accepted: 07/22/2019] [Indexed: 06/10/2023]
Abstract
Research on the impact of heat on pregnant women has focused largely on outcomes following extreme temperature events, such as particular heat waves or spells of very cold weather on pregnant women. Consistently, the literature has shown a statistically significant relationship between heat with shortened gestational age with studies concentrated largely in the western states of the USA or other nations. The association between heat and shortened gestational age has not been examined in the Southeastern US where maternal outcomes are some of the most challenging in the nation. Unlike previous studies that focus on the impacts of a single heat wave event, this study seeks to understand the impact of high heat over a 5-year period during the annual warm season (May-September). To achieve this goal, a case-crossover study design is employed to understand the impact of heat on preterm labor across regions in North Carolina (NC). Temperature thresholds for impact and the underlying relationships between preterm labor and heat are investigated using generalized additive models (GAM). Gridded temperature data (PRISM) is used to establish exposure classifications. The results reveal significant impacts to pregnant women exposed to heat with regional variations. The exposure variable with the most stable and significant result was minimum temperature, indicating high overnight temperatures have the most impact on preterm birth. The magnitude of this impact varies across regions from a 1% increase in risk to 6% increase in risk per two-degree increment above established minimum temperature thresholds.
Collapse
Affiliation(s)
- Ashley Ward
- Nicholas Institute of Environmental Policy Solution, Duke University, Box 90335, Durham, NC, 27708, USA.
| | - Jordan Clark
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jordan McLeod
- NOAA Southeast Regional Climate Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rachel Woodul
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Haley Moser
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Charles Konrad
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- NOAA Southeast Regional Climate Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
13
|
Bruhn WE, Rutkow L, Wang P, Tinker SE, Fahim C, Overton HN, Makary MA. Prevalence and Characteristics of Virginia Hospitals Suing Patients and Garnishing Wages for Unpaid Medical Bills. JAMA 2019; 322:691-692. [PMID: 31237609 PMCID: PMC6593627 DOI: 10.1001/jama.2019.9144] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study uses 2017 court records to characterize how frequently Virginia hospitals take legal action to garnish patients’ wages to recover unpaid medical expenses, and the characteristics of hospitals and patient employers associated with the actions.
Collapse
Affiliation(s)
- William E. Bruhn
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lainie Rutkow
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Peiqi Wang
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Christine Fahim
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Heidi N. Overton
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Martin A. Makary
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
14
|
Xu WY, Shooshtari A, Jung J(K. Disparities in cost‐related drug nonadherence under the Affordable Care Act. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2019. [DOI: 10.1111/jphs.12295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Wendy Yi Xu
- Division of Health Services Management and Policy College of Public Health The Ohio State University Columbus OH USA
| | - Andrew Shooshtari
- Department of Health Policy and Administration College of Health and Human Development Pennsylvania State University University Park PA USA
| | - Jeah (Kyoungrae) Jung
- Department of Health Policy and Administration College of Health and Human Development Pennsylvania State University University Park PA USA
| |
Collapse
|
15
|
Humphries B, Irwin A, Zoratti M, Xie F. How do financial (dis)incentives influence health behaviour and costs? Protocol for a systematic literature review of randomised controlled trials. BMJ Open 2019; 9:e024694. [PMID: 31023752 PMCID: PMC6501998 DOI: 10.1136/bmjopen-2018-024694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION In this era of rising healthcare costs, there is a growing interest in understanding how funding policies can be used to improve health and healthcare efficiency. Financial incentives (eg, vouchers or access to health insurance) or disincentives (eg, fines or out-of-pocket costs) affect behaviours. To date, reviews have explored the effects of financial (dis)incentives on patient health and behaviour by focusing on specific behaviours or geographical areas. The objective of this systematic review is to provide a comprehensive overview on the use of financial (dis)incentives as a means of influencing health-related behaviour and costs in randomised trials. METHODS AND ANALYSIS We will search electronic databases, clinical trial registries and websites of health economic organisations for randomised controlled trials. The initial searches, which were conducted on 13 January 2018, will be updated every 12 months until the completion of data analysis. The reference lists of included studies will be manually screened to identify additional eligible studies. Two researchers will independently review titles, abstracts and full texts to determine eligibility according to a set of predetermined inclusion criteria. Data will be extracted from included studies using a form developed and piloted by the research team. Discrepancies will be resolved through discussion with a third reviewer. Risk of bias will be assessed using the Cochrane Collaboration tool. ETHICS AND DISSEMINATION Ethics approval is not required since this is a review of published data. Results will be disseminated through publication in peer-reviewed journals and presentations at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42018097140.
Collapse
Affiliation(s)
- Brittany Humphries
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Irwin
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York City, New York, USA
| | - Michael Zoratti
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada
- Program for Health Economics and Outcome Measures (PHENOM), McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
16
|
Min KL, Koo H, Choi JJ, Kim DJ, Chang MJ, Han E. Utilization patterns of insulin for patients with type 2 diabetes from national health insurance claims data in South Korea. PLoS One 2019; 14:e0210159. [PMID: 30840630 PMCID: PMC6402628 DOI: 10.1371/journal.pone.0210159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 12/18/2018] [Indexed: 01/29/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a chronic disease that requires long-term therapy and regular check-ups to prevent complications. In this study, insurance claim data from the National Health Insurance Service (NHIS) of Korea were used to investigate insulin use in T2DM patients according to the economic status of patients and their access to primary physicians, operationally defined as the frequently used medical care providers at the time of T2DM diagnosis. A total of 91,810 participants were included from the NHIS claims database for the period between 2002 and 2013. The utilization pattern of insulin was set as the dependent variable and classified as one of the following: non-use of antidiabetic drugs, use of oral antidiabetic drugs only, or use of insulin with or without oral antidiabetic drugs. The main independent variables of interest were level of income and access to a frequently-visited physician. Multivariate Cox proportional hazards analysis was performed. Insulin was used by 9,281 patients during the study period, while use was 2.874 times more frequent in the Medical-aid group than in the highest premium group [hazard ratio (HR): 2.874, 95% confidence interval (CI): 2.588–3.192]. Insulin was also used ~50% more often in the patients managed by a frequently-visited physician than in those managed by other healthcare professionals (HR: 1.549, 95% CI: 1.434–1.624). The lag time to starting insulin was shorter when the patients had a low income and no frequently-visited physicians. Patients with a low level of income were more likely to use insulin and to have a shorter lag time from diagnosis to starting insulin. The likelihood of insulin being used was higher when the patients had a frequently-visited physician, particularly if they also had a low level of income. Therefore, the economic statuses of patients should be considered to ensure effective management of T2DM. Utilizing frequently-visited physicians might improve the management of T2DM, particularly for patients with a low income.
Collapse
Affiliation(s)
- Kyoung Lok Min
- Department of Pharmaceutical Medicine and Regulatory Sciences, Colleges of Medicine and Pharmacy, Yonsei University, Incheon, Republic of Korea
| | - Heejo Koo
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon, Republic of Korea
| | - Jun Jeong Choi
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon, Republic of Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Min Jung Chang
- Department of Pharmaceutical Medicine and Regulatory Sciences, Colleges of Medicine and Pharmacy, Yonsei University, Incheon, Republic of Korea
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon, Republic of Korea
- * E-mail: (EH); (MJC)
| | - Euna Han
- Department of Pharmaceutical Medicine and Regulatory Sciences, Colleges of Medicine and Pharmacy, Yonsei University, Incheon, Republic of Korea
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon, Republic of Korea
- * E-mail: (EH); (MJC)
| |
Collapse
|
17
|
Dandapani HG, Tieu K. The contemporary role of robotics in surgery: A predictive mathematical model on the short-term effectiveness of robotic and laparoscopic surgery. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2019. [DOI: 10.1016/j.lers.2018.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
|
18
|
Lee YH, Chiang T, Shelley M, Liu CT. Chinese residents' educational disparity and social insurance coverage. Int J Health Care Qual Assur 2019; 31:746-756. [PMID: 30354891 DOI: 10.1108/ijhcqa-06-2017-0098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The Chinese society has embraced rapid social reforms since the late twentieth century, including educational and healthcare systems. The Chinese Central Government launched an ambitious health reform program in 2009 to improve service quality and provide affordable health services, regardless of individual socio-economic status. Currently, the Chinese social health insurance includes Urban Employee Basic Medical Insurance, Urban Resident Basic Medical Insurance, and New Cooperative Medical Insurance for rural residents. The purpose of this paper is to measure the association between individual education level and China's social health insurance scheme following the reform. DESIGN/METHODOLOGY/APPROACH Using the latest (2011) China Health and Nutrition Survey (CHNS) data and multivariable logistic regression models with cross-sectional design ( n=11,960), the odds ratios (OR) and 95% confidence intervals (95% CI) are reported. FINDINGS The authors found that education is associated with all social health insurance schemes in China after the reform ( p<0.001). Residents with higher educational attainments, such as technical school (OR: 6.64, 95% CI: 5.44-8.13) or university and above (OR: 9.86, 95% CI: 8.14-11.96), are associated with UEBMI, compared with lower-educated individuals. PRACTICAL IMPLICATIONS The Chinese Central Government announced a plan to combine all social health insurance schemes by 2020, except UEBMI, a plan with the most comprehensive financial package. Further research is needed to investigate potential disparities after unification. Policy makers should continue to evaluate China's universal health coverage and social disparity. ORIGINALITY/VALUE This study is the first to investigate the association between residents' educational attainment and three social health insurance schemes following the 2009 health reform. The authors suggest that educational attainment is still associated with each social health insurance coverage after the ambitious health reform.
Collapse
Affiliation(s)
- Yen-Han Lee
- Indiana University School of Public Health , Bloomington, Indiana, USA
| | - Timothy Chiang
- Pennsylvania State University College of Medicine , Hershey, Pennsylvania, USA
| | | | - Ching-Ti Liu
- Boston University School of Public Health , Boston, Massachusetts, USA
| |
Collapse
|
19
|
Amanatullah DF, Murasko MJ, Chona DV, Crijns TJ, Ring D, Kamal RN. Financial Distress and Discussing the Cost of Total Joint Arthroplasty. J Arthroplasty 2018; 33:3394-3397. [PMID: 30057266 DOI: 10.1016/j.arth.2018.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/04/2018] [Accepted: 07/10/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total joint arthroplasty is expensive. Out-of-pocket cost to patients undergoing elective total joint arthroplasty varies considerably depending on their insurance coverage but can range into the tens of thousands of dollars. The goal of this study is to evaluate the association between patient financial stress and interest in discussing costs associated with surgery. METHODS One hundred forty-one patients undergoing elective total hip and knee arthroplasty at a suburban academic medical center were enrolled and completed questionnaires about cost prior to surgery. Questions regarding if and when doctors should discuss the cost of healthcare with patients, evaluating if patients were affected by the cost of healthcare and to what extent, and financial security scores to assess current financial situation were included. The primary outcome was the answer to the question of whether a doctor should discuss cost with patients. RESULTS Financial stress was found to be associated with patient experience of hardship due to cost of care [P = .004], likelihood to turn down a test or treatment due to copayment [P = .029], to decline a test or treatment due to other costs [P = .003], to experience difficulty affording basic necessities [P = .008], and to have used up all or most of their savings to pay for surgery [P = .011]. In total, 84% of patients reported that they wanted to discuss surgical costs with their doctors, but 90% did not want to do so at every visit. CONCLUSION Total joint arthroplasty creates considerable out-of-pocket costs that may affect patient decisions. These findings help elucidate important patient concerns that orthopedic surgeons should account for when discussing elective arthroplasty with patients.
Collapse
Affiliation(s)
- Derek F Amanatullah
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | - Marlon J Murasko
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | - Deepak V Chona
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | - Tom J Crijns
- Department of Surgery and Perioperative Care, University of Texas, Austin - Dell Medical School, Austin, Texas
| | - David Ring
- Department of Surgery and Perioperative Care, University of Texas, Austin - Dell Medical School, Austin, Texas
| | - Robin N Kamal
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| |
Collapse
|
20
|
Abstract
Charge markups for health care are variable and inflated several times beyond cost. Using the 2015 Medicare Provider Fee-For-Service Utilization and Payment Data file, we identified providers who billed for critical care hours and related procedures, including CPR, EKG interpretation, central line placement, arterial line placement, chest tube/thoracentesis, and emergent endotracheal intubation. Markup ratios (MRs), defined as the amount charged divided by the amount allowable, were calculated and compared; 42.1 per cent of physicians billing for critical care–related services were specialized in emergency medicine (EM). EM had the highest overall MR (median 4.99, IQR 3.60–6.88) and provided most of the services. MRs differed between genders in select cases (critical care hours: anesthesiology, EM, internal medicine, pulmonary and critical care medicine; CPR, pulmonary and critical care medicine; chest tube placement/thoracentesis, internal medicine). These differences in MR did not correspond to higher rates of Medicare allowable amounts ( P = NS). In conclusion, charge markups significantly varied by physician specialty. EM physicians had the highest MRs for most critical care–related services, including critical care hours, EKG interpretation, CPR, central venous line placement, and emergent endotracheal intubation. EM physicians also provided most of these services. Charge markups are associated with adverse consequences and represent potential targets for cost containment and consumer protection.
Collapse
Affiliation(s)
- Joshua Tseng
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Harry C. Sax
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Rodrigo F. Alban
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| |
Collapse
|
21
|
Latimer T, Roscamp J, Papanikitas A. Patient-centredness and consumerism in healthcare: an ideological mess. J R Soc Med 2017; 110:425-427. [PMID: 28949269 DOI: 10.1177/0141076817731905] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Tara Latimer
- 1 King's College London, Faculty of Life Sciences and Medicine, London SE1 1UL, UK
| | - Joseph Roscamp
- 1 King's College London, Faculty of Life Sciences and Medicine, London SE1 1UL, UK
| | - Andrew Papanikitas
- 2 Nuffield Department of Primary Care Health Sciences, 6396 Oxford University , Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| |
Collapse
|
22
|
Abstract
Although research suggests why disability may cause poverty, it is not well understood why poverty may cause disability. This article presents the Poverty Disability Model, which includes four groups of factors that increase the risk that poverty will cause disability and chronic health problems. Rehabilitation interventions and counselor implications derived from the model are presented in addition to research.
Collapse
|
23
|
Richman IB, Brodie M. A National study of burdensome health care costs among non-elderly Americans. BMC Health Serv Res 2014; 14:435. [PMID: 25252706 PMCID: PMC4261537 DOI: 10.1186/1472-6963-14-435] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 09/16/2014] [Indexed: 11/16/2022] Open
Abstract
Background Rising health care costs and increased cost sharing have resulted in significant medical expenses for many Americans. The goal of this study was to describe the prevalence of and risk factors for burdensome health care costs among non-elderly Americans. Methods This was a cross sectional study of a nationally representative sample of non-elderly Americans. We used survey data previously collected by the Kaiser Family Foundation. We used logistic regression to identify key risk factors for burdensome health care costs and to assess whether risk factors differ according to age within our study population. For analyses comparing younger and middle-aged adults, we compared participants ages 18–39 (younger Americans) to those ages 40–64 (middle-aged Americans). Results Our study population included 5,493 participants. Twenty seven percent of participants reported difficulty paying medical bills, a prevalence that did not differ by age. Low income, lack of health insurance, and poor health were independently associated with difficulty paying medical bills after controlling for demographic covariates. Both younger and middle-aged adults were likely to experience burdensome health care costs at low incomes. At moderate incomes, risk fell for middle-aged adults, but remained high for younger adults (ORmiddle-age 1.40, 95% CI 1.12-1.75, ORyounger 2.48, 95% CI 1.73-3.57, p value for interaction 0.004). Younger adults without insurance were at risk for accruing burdensome costs compared to their insured counterparts (OR 2.61, 95% CI 1.96-3.47). Middle-aged adults without insurance, though, had an even higher risk (OR 3.82, 95% CI 2.93-4.97, p value for interaction 0.037). Conclusions Both younger and middle-aged adults commonly report difficulty paying medical bills. Younger adults remain vulnerable to burdensome medical costs even when earning moderate incomes. Middle-aged adults, however, are more likely to encounter burdensome costs when uninsured. These findings suggest that younger and middle-aged adults experience distinct vulnerabilities and may benefit differentially from health reform efforts intended to expand coverage and limit out-of-pocket expenses.
Collapse
Affiliation(s)
- Ilana B Richman
- Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA, USA.
| | | |
Collapse
|
24
|
Moser RP, Arndt J, Han PK, Waters EA, Amsellem M, Hesse BW. Perceptions of cancer as a death sentence: prevalence and consequences. J Health Psychol 2013; 19:1518-24. [PMID: 23864071 DOI: 10.1177/1359105313494924] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Research suggests that perceiving cancer as a death sentence is a critical determinant of health care-seeking behaviors. However, there is limited information regarding the prevalence of this perception in the US population. Cross-sectional analysis of data (n = 7674 adults) from the 2007-2008 administration of the nationally representative Health Information National Trends Survey (HINTS 3) was performed. A majority (61.6%) of respondents perceived cancer as death sentence, and more than one-third (36%) of respondents reported that they avoid seeing their physicians. In the adult US population, perceiving cancer as a death sentence is common and is associated with education level and avoidance of physicians.
Collapse
|
25
|
Bruning J, Arif AA, Rohrer JE. Medical cost and frequent mental distress among the non-elderly US adult population. J Public Health (Oxf) 2013; 36:134-9. [PMID: 23554508 DOI: 10.1093/pubmed/fdt029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Frequent mental distress (FMD) is an important measure of perceived poor mental health. With the rising cost of health care, it is not uncommon for working adults to delay seeking care. The objective of this study was to determine the relationship between avoidance of medical care due to cost and FMD among the non-elderly US population. METHODS We analyzed data from 282 044 non-elderly US population from a 2008 Behavioral Risk Factor Surveillance System survey. Multivariable logistic regression models were used to assess the association between avoidance of medical care due to cost and FMD adjusted for covariates. RESULTS The overall prevalence of FMD in the non-elderly population was 11.1%; whereas it was 24.2% for those reporting avoiding medical care due to cost. Approximately 18% of the population had no health insurance coverage and the prevalence of FMD was significantly greater in this group. The odds of FMD were >2-fold elevated for respondents who were unable to see a doctor because of cost (adjusted odds ratio: 2.40, 99% confidence interval: 2.19, 2.63). CONCLUSIONS These findings highlight the need for affordable medical care for reducing mental distress and improving population health.
Collapse
Affiliation(s)
- John Bruning
- District Health Department No. 4, Alpena Michigan, USA
| | | | | |
Collapse
|
26
|
Huber CA, Rüesch P, Mielck A, Böcken J, Rosemann T, Meyer PC. Effects of cost sharing on seeking outpatient care: a propensity-matched study in Germany and Switzerland. J Eval Clin Pract 2012; 18:781-7. [PMID: 21518398 DOI: 10.1111/j.1365-2753.2011.01679.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several studies have assessed the effect of cost sharing on health service utilization (HSU), mostly in the USA. Results are heterogeneous, showing different effects. Whereas previous studies compared insurants within one health care system but different modes of insurance, we aimed at comparing two different health care systems in Europe: Germany and Switzerland. Furthermore, we assessed the impact of cost sharing depending on socio-demographic factors as well as health status. METHODS Two representative samples of 5197 Swiss insurants with and 5197 German insurants without cost sharing were used to assess the independent association between cost sharing and the use of outpatient care. To minimize confounding, we performed cross-sectional analyses between propensity score matched Swiss and German insurants. We investigated subgroups according to health and socio-economic status to assess a potential social gradient in HSU. RESULTS We found a significant association between health insurance scheme and the use of outpatient services. German insurants without cost sharing (visit rate: 4.8 per year) consulted a general practitioner or specialist more frequently than Swiss insurants with cost sharing (visit rate: 3.0 per year; P < 0.01). Subgroup analyses showed that vulnerable populations were differently affected by cost sharing. In the group of respondents with poor health and low socio-economic status, the cost-sharing effect was strongest. CONCLUSION Cost-sharing models reduce HSU. The challenge is to create cost-sharing models which do not preclude vulnerable populations from seeking essential health care.
Collapse
Affiliation(s)
- Carola A Huber
- Head of Department, Institute of General Practice and Health Services Research, University of Zürich, Zürich, Switzerland.
| | | | | | | | | | | |
Collapse
|
27
|
Lim SW, Kwon YS, Ha J, Yoon HG, Bae SM, Shin DW, Shin YC, Oh KS. Comparison of treatment adherence between selective serotonin reuptake inhibitors and moclobemide in patients with social anxiety disorder. Psychiatry Investig 2012; 9:73-9. [PMID: 22396688 PMCID: PMC3285744 DOI: 10.4306/pi.2012.9.1.73] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 08/30/2011] [Accepted: 09/09/2011] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE With respect to the pharmacotherapy of social anxiety disorder (SAD), it has been suggested that treatment duration is an important factor that can significantly predict responses. The present study aimed to compare the treatment adherence of SAD patients who were taking either SSRIs or reversible inhibitors of MAO-A (moclobemide) by measuring treatment duration and all-cause discontinuation rates of pharmacotherapy in a natural clinical setting. METHODS We retrospectively analysed the data of 172 patients diagnosed with SAD. Depending on their medication, we divided the patients into two groups, SSRI (n=54) or moclobemide (n=118). The expected number of all-cause discontinuation every 2 weeks after starting treatment was calculated by life table survival methods. A multi-variable Cox proportional hazard regression was used to analyze the potential influence of explanatory variables. RESULTS Treatment duration was significantly longer in the SSRI group [46.41±56.96, median=12.0 (weeks)] than in the moclobemide group [25.53±34.74, median=12.0 (weeks), Z=2.352, p=0.019]. Overall, all-cause discontinuation rates were significantly lower with SSRIs (81%) than moclobemide (96%, χ²=4.532, p=0.033). CONCLUSION The SSRI group had a longer treatment duration and lower all-cause discontinuation rate than moclobemide. Further, only the type of medication had a significant effect on all-cause discontinuation rates and therefore, we could predict better treatment adherence with the SSRIs in the treatment of SAD.
Collapse
Affiliation(s)
- Se-Won Lim
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong-Seok Kwon
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Juwon Ha
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeng-Geun Yoon
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Min Bae
- Department of Psychiatry, Gil Hospital, Gachon University of Medicine and Science, Incheon, Korea
| | - Dong-Won Shin
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Chul Shin
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kang-Seob Oh
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
28
|
Clarke TC, Arheart KL, Muennig P, Fleming LE, Caban-Martinez AJ, Dietz N, Lee DJ. Health care access and utilization among children of single working and nonworking mothers in the United States. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2011; 41:11-26. [PMID: 21319718 DOI: 10.2190/hs.41.1.b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
To examine indicators of health care access and utilization among children of working and nonworking single mothers in the United States, the authors used data on unmarried women participating in the 1997-2008 National Health Interview Survey who financially supported children under 18 years of age (n = 21,842). Stratified by maternal employment, the analyses assessed health care access and utilization for all children. Outcome variables included delayed care, unmet care, lack of prescription medication, no usual place of care, no well-child visit, and no doctor's visit. The analyses reveal that maternal employment status was not associated with health care access and utilization. The strongest predictors of low access/utilization included no health insurance and intermittent health insurance in the previous 12 months, relative to those with continuous private health insurance coverage (odds ratio ranges 3.2-13.5 and 1.3-10.3, respectively). Children with continuous public health insurance compared favorably with those having continuous private health insurance on three of six access/utilization indicators (odds ratio range 0.63-0.85). As these results show, health care access and utilization for the children of single mothers are not optimal. Passage of the U.S. Healthcare Reform Bill (HR 3590) will probably increase the number of children with health insurance and improve these indicators.
Collapse
Affiliation(s)
- Tainya C Clarke
- Department of Epidemiology and Public Health, University of Miami, Miller School of Medicine, Miami, FL 33136, USA.
| | | | | | | | | | | | | |
Collapse
|
29
|
Smolderen KG, Spertus JA, Nallamothu BK, Krumholz HM, Tang F, Ross JS, Ting HH, Alexander KP, Rathore SS, Chan PS. Health care insurance, financial concerns in accessing care, and delays to hospital presentation in acute myocardial infarction. JAMA 2010; 303:1392-400. [PMID: 20388895 PMCID: PMC3020978 DOI: 10.1001/jama.2010.409] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Little is known about how health insurance status affects decisions to seek care during emergency medical conditions such as acute myocardial infarction (AMI). OBJECTIVE To examine the association between lack of health insurance and financial concerns about accessing care among those with health insurance, and the time from symptom onset to hospital presentation (prehospital delays) during AMI. DESIGN, SETTING, AND PATIENTS Multicenter, prospective study using a registry of 3721 AMI patients enrolled between April 11, 2005, and December 31, 2008, at 24 US hospitals. Health insurance status was categorized as insured without financial concerns, insured but have financial concerns about accessing care, and uninsured. Insurance information was determined from medical records while financial concerns among those with health insurance were determined from structured interviews. MAIN OUTCOME MEASURE Prehospital delay times (< or = 2 hours, > 2-6 hours, or > 6 hours), adjusted for demographic, clinical, and social and psychological factors using hierarchical ordinal regression models. RESULTS Of 3721 patients, 2294 were insured without financial concerns (61.7%), 689 were insured but had financial concerns about accessing care (18.5%), and 738 were uninsured (19.8%). Uninsured and insured patients with financial concerns were more likely to delay seeking care during AMI and had prehospital delays of greater than 6 hours among 48.6% of uninsured patients and 44.6% of insured patients with financial concerns compared with only 39.3% of insured patients without financial concerns. Prehospital delays of less than 2 hours during AMI occurred among 36.6% of those insured without financial concerns compared with 33.5% of insured patients with financial concerns and 27.5% of uninsured patients (P < .001). After adjusting for potential confounders, prehospital delays were associated with insured patients with financial concerns (adjusted odds ratio, 1.21 [95% confidence interval, 1.05-1.41]; P = .01) and with uninsured patients (adjusted odds ratio, 1.38 [95% confidence interval, 1.17-1.63]; P < .001). CONCLUSION Lack of health insurance and financial concerns about accessing care among those with health insurance were each associated with delays in seeking emergency care for AMI.
Collapse
Affiliation(s)
- Kim G. Smolderen
- Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University, Tilburg, The Netherlands
| | - John A. Spertus
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri – Kansas City, MO
| | - Brahmajee K. Nallamothu
- VA Health Services Research and Development Center for Excellence and Department of Medicine, University of Michigan, Medical School, Ann Arbor, MI
| | - Harlan M. Krumholz
- The Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine; the Section of Health Policy and Administration, Department of Epidemiology and Public Health; the Center for Outcomes Research and Evaluation; Yale New Haven Hospital, New Haven, CT
- MD/PhD Program, Yale University School of Medicine, New Haven, CT
| | - Fengming Tang
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
| | - Joseph S. Ross
- Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, NY
- HSR&D Research Enhancement Award Program and Geriatrics Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, NY
| | - Henry H. Ting
- Division of Cardiovascular Diseases and Mayo Clinic College of Medicine, Rochester, MN
| | - Karen P. Alexander
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Saif S. Rathore
- MD/PhD Program, Yale University School of Medicine, New Haven, CT
| | - Paul S. Chan
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri – Kansas City, MO
| |
Collapse
|
30
|
Lam AY, Rose D. Telepharmacy services in an urban community health clinic system. J Am Pharm Assoc (2003) 2009; 49:652-9. [DOI: 10.1331/japha.2009.08128] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
31
|
Olfson M, Mojtabai R, Sampson NA, Hwang I, Druss B, Wang PS, Wells KB, Pincus HA, Kessler RC. Dropout from outpatient mental health care in the United States. Psychiatr Serv 2009; 60:898-907. [PMID: 19564219 PMCID: PMC2774713 DOI: 10.1176/appi.ps.60.7.898] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Although mental health treatment dropout is common, patterns and predictors of dropout are poorly understood. This study explored patterns and predictors of mental health treatment dropout in a nationally representative sample. METHODS Data were from the National Comorbidity Survey Replication, a nationally representative household survey. Respondents who had received mental health treatment in the 12 months before the interview (N=1,664) were asked about dropout, which was defined as quitting treatment before the provider wanted them to stop. Cross-tabulation and discrete-time survival analyses were used to identify predictors. RESULTS Approximately one-fifth (22%) of patients quit treatment prematurely. The highest dropout rate was from treatment received in the general medical sector (32%), and the lowest was from treatment received by psychiatrists (15%). Dropout rates were intermediate from treatment in the human services sector (20%) and among patients seen by nonpsychiatrist mental health professionals (19%). Over 70% of all dropout occurred after the first or second visits. Mental health insurance was associated with low odds of dropout (odds ratio=.6, 95% confidence interval=.4-.9). Psychiatric comorbidity was associated with a trend toward dropout. Several patient characteristics differentially predicted dropout across treatment sectors and in early and later phases of treatment. CONCLUSIONS Roughly one-fifth of adults in mental health treatment dropped out before completing the recommended course of treatment. Dropout was most common in the general medical sector and varied by patient characteristics across treatment sectors. Interventions focused on high-risk patients and sectors that have higher dropout rates will likely be required to reduce the large proportion of patients who prematurely terminate treatment.
Collapse
|
32
|
Olfson M, Mojtabai R, Sampson NA, Hwang I, Druss B, Wang PS, Wells KB, Pincus HA, Kessler RC. Dropout from outpatient mental health care in the United States. Psychiatr Serv 2009; 60:898-907. [PMID: 19564219 PMCID: PMC2774713 DOI: 10.1176/ps.2009.60.7.898] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Although mental health treatment dropout is common, patterns and predictors of dropout are poorly understood. This study explored patterns and predictors of mental health treatment dropout in a nationally representative sample. METHODS Data were from the National Comorbidity Survey Replication, a nationally representative household survey. Respondents who had received mental health treatment in the 12 months before the interview (N=1,664) were asked about dropout, which was defined as quitting treatment before the provider wanted them to stop. Cross-tabulation and discrete-time survival analyses were used to identify predictors. RESULTS Approximately one-fifth (22%) of patients quit treatment prematurely. The highest dropout rate was from treatment received in the general medical sector (32%), and the lowest was from treatment received by psychiatrists (15%). Dropout rates were intermediate from treatment in the human services sector (20%) and among patients seen by nonpsychiatrist mental health professionals (19%). Over 70% of all dropout occurred after the first or second visits. Mental health insurance was associated with low odds of dropout (odds ratio=.6, 95% confidence interval=.4-.9). Psychiatric comorbidity was associated with a trend toward dropout. Several patient characteristics differentially predicted dropout across treatment sectors and in early and later phases of treatment. CONCLUSIONS Roughly one-fifth of adults in mental health treatment dropped out before completing the recommended course of treatment. Dropout was most common in the general medical sector and varied by patient characteristics across treatment sectors. Interventions focused on high-risk patients and sectors that have higher dropout rates will likely be required to reduce the large proportion of patients who prematurely terminate treatment.
Collapse
|
33
|
Abstract
The United States has 45 million individuals who lack health insurance, causing them to experience higher morbidity and mortality rates. One method for funding the uninsured includes creating an annuity (federally funded at $1,000 per year for the first 5 years of one's life) for each newborn. When the annuity matures, at the age of 45 years, the individual will have a large health care fund. When coupled with options such as familial vesting, within a few generations, these annuities have the capacity to ultimately provide health care coverage from birth through old age.
Collapse
|
34
|
Smedley BD. Moving beyond access: achieving equity in state health care reform. Health Aff (Millwood) 2008; 27:447-55. [PMID: 18332501 DOI: 10.1377/hlthaff.27.2.447] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Institute of Medicine's 2003 Unequal Treatment report raised the public's and policymakers' awareness of racial and ethnic health care disparities, but federal policy-makers have implemented few of the report's more than two dozen recommendations. State health care reform efforts, however, are gaining support around the country and have great potential to reduce health care inequality. This paper offers a policy framework to explore how states can move toward eliminating disparities by addressing health care access and quality, state health care infrastructure, patient and community empowerment, state policy infrastructure, and social and community determinants of health.
Collapse
|
35
|
Reed DB, Rayens MK, Winter K, Zhang M. Health Care Delay of Farmers 50 Years and Older in Kentucky and South Carolina. J Agromedicine 2008; 13:71-9. [DOI: 10.1080/10599240802202711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
36
|
Exploring the determinants of racial and ethnic disparities in total knee arthroplasty: health insurance, income, and assets. Med Care 2008; 46:481-8. [PMID: 18438196 DOI: 10.1097/mlr.0b013e3181621e9c] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate national total knee arthroplasty (TKA) rates by economic factors, and the extent to which differences in insurance coverage, income, and assets contribute to racial and ethnic disparities in TKA use. DATA SOURCE US longitudinal Health and Retirement Study survey data for the elderly and near-elderly (biennial rounds 1994-2004) from the Institute of Social Research, University of Michigan. STUDY DESIGN The outcome is dichotomous, whether the respondent received first TKA in the previous 2 years. Longitudinal, random-effects logistic regression models are used to assess associations with lagged economic indicators. SAMPLE Sample was 55,469 person-year observations from 18,439 persons; 663, with first TKA. RESULTS Racial/ethnic disparities in TKA were more prominent among men than women. For example, relative to white women, odds ratios (ORs) were 0.94, 0.46, and 0.79, for white, black, and Hispanic men, respectively (P < 0.05 for black men). After adjusting for economic factors, racial/ethnic differences in TKA rates for women essentially disappeared, while the deficit for black men remained large. Among Medicare-enrolled elderly, those with supplemental insurance may be more likely to have first TKA compared with those without it, whether the supplemental coverage was private [OR: 1.27; 95% confidence interval (CI): 0.82-1.96] or Medicaid (OR: 1.18; 95% CI: 0.93-1.49). Among the near-elderly (age 47-64), compared with the privately insured, the uninsured were less likely (OR: 0.61; 95% CI: 0.40-0.92) and those with Medicaid more likely (OR: 1.53; 95% CI: 1.03-2.26) to have first TKA. CONCLUSIONS Limited insurance coverage and financial constraints explain some of the racial/ethnic disparities in TKA rates.
Collapse
|