Medicaid programs provide a safety net for the uninsured, but they also crowd out private insurance

2000 ◽  
Keyword(s):  
Private Insurance ◽  
Safety Net ◽  
Crowd Out

The Vanishing Health Care Safety Net: New Data on Uninsured Americans

1992 ◽  
Vol 22 (3) ◽  
pp. 381-396 ◽  
Author(s):  
David U. Himmelstein ◽  
Steffie Woolhandler ◽  
Sidney M. Wolfe
Keyword(s):  
Private Insurance ◽  
Health Spending ◽  
Poverty Line ◽  
Safety Net ◽  
Census Bureau ◽  
Public Programs ◽  
Teachers College ◽  
Health Care Safety Net ◽  
Working Age ◽  
Uninsured Children

New data obtained from the Census Bureau shows that the number of Americans without any health insurance increased by 1.3 million between 1989 and 1990, bringing the total number of uninsured to 34.7 million, more than at any time since the passage of Medicare and Medicaid 25 years ago. This increase coincided with a 10.5 percent increase in health spending, the second largest in the past three decades. The number of people covered by Medicaid grew by 3.1 million, due to a one-time expansion of eligibility mandated by Congress, but this was more than counterbalanced by a population growth of 3 million and a decrease of 1.3 million in people covered by private insurance. Had Medicaid not been expanded, the number of uninsured would have increased by 4.4 million. The increase in the uninsured affected virtually all parts of the nation. Seven states had increases of more than 100,000 persons each. Only Texas experienced a decrease of that magnitude, but still had the second highest rate of uninsurance of any state. Of the 1.3 million additional uninsured in 1990, 77 percent were male, 32 percent had family incomes in excess of $50,000 per year, and 74 percent had annual family incomes above $25,000. Fewer than 9 percent had incomes below the poverty line. The numbers of uninsured children and senior citizens fell slightly (but not significantly), while the number of uninsured working-age adults rose by 1.4 million. The number of uninsured workers in each of four of 20 major industry groups increased by more than 100,000 in 1990. None of the industry groups showed a significant decline in the number of uninsured. Among professionals, there were substantial numbers of uninsured doctors, engineers, teachers, college professors, clergy, and others, but all legislators and judges were insured. The data presented here largely predate the recession and understate current problems. In 1991 the number of uninsured will likely reach nearly 40 million. Also, these estimates are based on the number of people uninsured at a single time during 1990; a far higher number were temporarily uninsured at some point during the year. Moreover the Census Bureau survey ignores the problem of the underinsurance of at least 50 million insured Americans. Patchwork public programs are grossly inadequate to plug the holes. A national health program covering all Americans could assure access to care and contain costs.

scholarly journals Puratchi Thalaivi Amma’s Medical Insurance Scheme – A Boon for the Despondent Unorganized Sector - A Preliminary Case Study on The Penetration of Private Insurance Companies on the Unorganized Sector of Chennai City

2019 ◽  
pp. 35-44
Author(s):  
M. Mohan Kumar ◽  
Dr. P. Thiyagarajan ◽  
P. Sarvaharana
Keyword(s):  
General Public ◽  
Private Insurance ◽  
Safety Net ◽  
Vital Role ◽  
Insurance Companies ◽  
Insurance Sector ◽  
Rural And Urban ◽  
Chennai City ◽  
Unorganized Sector

The Insurance sector plays a vital role in the planned economic development, as it not only aims to boost saving habit; but also become a safety-net both for the rural and urban sector. It also aims to generate long-term funds for infrastructural development. Besides, Insurance protects enterprises against risks such as fire and natural calamities. For the general public insurance comes to their aid towards health care, life, property and pension. Therefore,insurance growth and development is synonymous to the growth of an economy wherein it not only safeguards the interest of the industry but the general public as well.

scholarly journals New digital safety net or just more ‘friendfunding’? Institutional analysis of medical crowdfunding in the United States

2020 ◽  
Author(s):  
Sumin Lee ◽  
Vili Lehdonvirta
Keyword(s):  
Private Insurance ◽  
Insurance Coverage ◽  
Safety Net ◽  
The United States ◽  
Safety Nets ◽  
Transformative Potential ◽  
Societal Context ◽  
Quantitative Analyses ◽  
Social Associations ◽  
Socioeconomic Data

Crowdfunding is becoming a popular way of financing healthcare. Some commentators suggest that crowdfunding could serve as a new institution that fills gaps in conventional safety nets. Others suggest that crowdfunding is simply another way of obtaining help from family, friends, and local associations, and has little transformative potential. We provide one of the first quantitative analyses of medical crowdfunding, and the first to model the broader societal context in which campaigns are situated. We scraped data on US medical campaigns from the leading platform, and combined them with county-level socioeconomic data to model predictors of campaign frequency and success. Our findings suggest that many seek help from crowdfunding when both formal and informal conventional safety nets fail them. Significantly more campaigns are initiated in US counties with poorer private insurance coverage, lower social security provision, fewer social associations, and weaker cultures of giving. However, campaigns are least likely to reach their goals where most needed. Campaigns are more likely to be successful in counties that are wealthier and healthier, and have more social associations. Crowdfunding is not merely ‘friendfunding’: fundraisers can increase their chances of success by having their appeals widely shared on social media. However, the returns to sharing are greater for campaigns initiated in wealthier areas. Overall, our findings suggest that medical crowdfunding is an entrepreneurial safety net: one where protection is not afforded universally or on the basis of need, but on the basis of one’s ability to appeal to the audience and out- compete rivaling needfuls.

Abstract 112: Statin Utilization in the Outpatient Clinic of a University Based Residency Training Program

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Eric Chang ◽  
Demilade Adedinsewo ◽  
Camille Calcano ◽  
Obiora Egbuche ◽  
Aneese Chaudhry ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Outpatient Clinic ◽  
Patient Population ◽  
Private Insurance ◽  
Safety Net ◽  
Atherosclerotic Cardiovascular Disease ◽  
Specific Patient ◽  
Factors Affecting ◽  
Safety Net Hospital ◽  
National Estimates

Background: Current guidelines released in 2013 recommend statins for five specific patient groups including persons with clinical atherosclerotic cardiovascular disease (ASCVD) and diabetes. National estimates of statin utilization in 2012 report statin use in persons with ASCVD at 58.8% and 63.5% among persons with diabetes. A recent review also showed suboptimal statin prescription rates prior to 2013, with only 23% being prescribed a statin at goal dose. Our goal was to assess statin prescriptions in a large resident run outpatient clinic and identify factors affecting statin prescriptions as potential targets for intervention to improve compliance with the guidelines. Methods: We obtained data from the medical record data warehouse of a primary care outpatient clinic within a large safety-net hospital from Jan–Dec 2015. The clinic is predominantly run by internal medicine residents and supervised by general internal medicine attending physicians. Patients with a diagnosis of ASCVD and diabetes were identified and electronic medical records abstraction was done to identify persons who were prescribed a statin (regardless of dose). Bivariate analyses were conducted to identify potential factors affecting statin prescriptions. Results: Our patient population was predominantly African American, representing more than 70% of our clinic patients. We found 87% of persons with ASCVD and 70% of persons with diabetes were on statin. We found no differences in statin prescriptions by demographic characteristics among persons with ASCVD. Among patients with diabetes, younger age (p<0.01), female sex (p<0.05), non-black race (p<0.05) and private insurance/lack of insurance (p<0.01) were associated with a lower likelihood of being prescribed a statin. Conclusion: Statin prescriptions among patients with ASCVD and diabetes appear to be higher in our patient population compared to prior national estimates, however statin prevalence remains suboptimal. Our next steps are to begin a targeted educational intervention for residents in the continuity clinic and ultimately demonstrate that resident driven intervention is an effective way to increase compliance with the guidelines.

Factors Affecting Compliance With Myringotomy Tube Follow-up Care

2022 ◽  
pp. 000348942110722
Author(s):  
Helen H. Soh ◽  
Katherine R. Keefe ◽  
Madhav Sambhu ◽  
Tithi D. Baul ◽  
Dillon B. Karst ◽  
...  
Keyword(s):  
Medical Center ◽  
Private Insurance ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Safety Net ◽  
Tube Placement ◽  
Factors Affecting ◽  
Urban Safety

Objective: Myringotomy and tube insertion is a commonly practiced procedure within pediatric otolaryngology. Though relatively safe, follow-up appointments are critical in preventing further complications and monitoring for improvement. This study sought to evaluate the factors associated with compliance of post-myringotomy follow-up visits in an urban safety-net tertiary care setting. Methods: This study is a retrospective chart review conducted in outpatient otolaryngology clinic at an urban, safety-net, tertiary-care, academic medical center. All patients from ages 0 to 18 who received myringotomy and tube placement between February 3, 2012, to May 30, 2018 at the aforementioned clinic were included. Results: A total of 806 patients had myringotomy tubes placed during this period; 190 patients were excluded due to no visits being scheduled within 1 and 6 month visit windows post-operatively, leaving 616 patients included for analysis. Of 616 patients, 574 patients were seen for the 1-month visit, (42 patients did not have follow-up visits within the 1-month window), and 356 patients were examined for the 6-month visit (260 patients did not schedule follow-up visits within the 6-month window). For the 1-month follow-up visits post-procedure, only race/ethnicity type “Other” was associated with lower no-show rates (OR = 0.330, 95% CI: 0.093-0.968). With the 6-month follow-up visits, having private insurance (OR = 0.446, 95% CI: 0.229-0.867) and not having a 1-month visit scheduled (OR = 0.404, 95% CI: 0.174-0.937) predicted lower no-show rates. Conclusion: No meaningful factors studied were significantly associated with compliance of short-term, 1-month visits post-myringotomy. Compliance of longer-term, 6-month post-operative visits was associated with insurance type and previous visit status.

scholarly journals Relationship Between Hepatitis C Clinical Testing Site and Linkage to Care

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Sabrina A. Assoumou ◽  
Wei Huang ◽  
C. Robert Horsburgh ◽  
Mari-Lynn Drainoni ◽  
Benjamin P. Linas
Keyword(s):  
Hepatitis C ◽  
Private Insurance ◽  
Linkage To Care ◽  
Safety Net ◽  
Hcv Rna ◽  
Safety Net Hospital ◽  
Urban Safety ◽  
Control And Prevention ◽  
Multivariable Regression ◽  
Testing Site

Abstract Background.  The Centers for Disease Control and Prevention recommends one-time hepatitis C virus (HCV) testing of the population born between 1945 and 1965 with follow-up RNA testing for those with reactive serology. To increase the rate of diagnosis, testing may be considered in settings other than outpatient clinics (OC), such as inpatient wards (IP) or emergency department (ED). Methods.  We used electronic medical records to create a retrospective cohort with reactive HCV serology between 2005 and 2010 at an urban safety net hospital. We determined factors associated with linkage to HCV care as measured by HCV RNA testing, and we evaluated the rate of linkage to care according to diagnosis location (OC, IP, or ED). Results.  Individuals, 37 828, were tested and 5885 (16%) were reactive. Seropositivity was similar across all sites. Of the 4466 patients who met inclusion criteria, 3400 (76%) were diagnosed in the OC, whereas 967 (22%) and 99 (2%) were tested in the IP and the ED, respectively. A total of 2135 (48%) underwent HCV RNA testing. Using multivariable regression modeling, the following factors were independently associated with HCV RNA testing: diagnosis in the OC (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.42–1.90); age at diagnosis in decades (OR, 0.98; 95% CI, 0.98–0.99); private insurance (OR, 1.17; 95% CI, 1.01–1.34); and ≥10 visits after diagnosis (OR, 2.15; 95% CI, 1.89–2.44). Conclusion.  There is an opportunity to increase HCV diagnosis by testing in sites other than the OC, but this opportunity needs to be coupled with robust initiatives to improve linkage to care.

scholarly journals Take-Up of Public Insurance and Crowd-out of Private Insurance Under Recent CHIP Expansions to Higher Income Children

2011 ◽  
Author(s):  
Carole Roan Gresenz ◽  
Sarah Edgington ◽  
Miriam Laugesen ◽  
José Escarce
Keyword(s):  
Private Insurance ◽  
Public Insurance ◽  
Crowd Out

scholarly journals 16: POSTPARTUM DEPRESSION SCREENING IN A PEDIATRIC ED

2016 ◽  
Vol 64 (3) ◽  
pp. 813.1-813
Author(s):  
L Jarvis ◽  
G Badolato ◽  
K Breslin ◽  
M Goyal
Keyword(s):  
Postpartum Depression ◽  
Positive Impact ◽  
Private Insurance ◽  
Depression Scale ◽  
Safety Net ◽  
Suicidal Thoughts ◽  
Convenience Sample ◽  
Factors Associated ◽  
Young Infants

Purpose of StudyPostpartum depression (PPD) occurs in up to 20% of mothers. The American Academy of Pediatrics recommends routine screening for PPD. The pediatric emergency department (PED) serves as a safety-net for vulnerable, high-risk populations, and may be a useful site for screening. This study investigates (1) prevalence of PPD positive screens, (2) factors associated with a positive PPD screen, (3) frequency of mothers who had not completed a PPD screen previously, and (3) acceptability and impact of PPD screening.Methods UsedWe performed a prospective, cross-sectional survey of a convenience sample of mothers of infants </=6 months of age presenting with low-acuity complaints. Mothers completed a computerized survey that included a validated PPD screening tool (Edinburgh Postnatal Depression Scale). We calculated frequency of positive screens and performed bivariable logistic regression to identify factors associated with a positive PPD screen. PPD positive-screened mothers were contacted for phone follow-up at one-month.Summary of Results121 mothers were screened for PPD (mean age=28± SD 6 years; 86% English vs. Spanish language; 50% non-Hispanic Black race/ethnicity; 75% non-private insurance) during presentation to the ED with their infant (mean age=3±SD 2 months; 51% female). Twenty-seven mothers (22%) screened positive for PPD with eight mothers (7%) reporting suicidal thoughts. Forty-seven percent (57/121) of mothers had never previously been screened, including 59% (16/27) of PPD-positive screened and those endorsing suicidal thoughts (5/8, 63%). Infants of PPD-screened positive mothers had more ED visits than those whose mothers screened negative (median 2 vs. 1). Seventy-four percent (90/121) of participants viewed ED-based PPD screening favorably. At one-month follow-up 100% (n=12) reported ED-based PPD screening acceptable and the majority endorsed positive impact of screening, including increased access to support (8/12, 67%) and improved activities of daily living (10/12, 83%).ConclusionsPPD is reported by approximately 1 in 5 mothers in an urban PED and the majority of PED-screen positive mothers had not been screened previously. PED-based screening was well-accepted and had a positive impact. Our study informs future efforts for interventions to support mothers of young infants who use the PED for care.

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