In search of real autonomy for fertility patients

2014 ◽  
Vol 10 (3) ◽  
pp. 243-250 ◽  
Author(s):  
Josephine Johnston ◽  
Michael K. Gusmano ◽  
Pasquale Patrizio
Keyword(s):  
United States ◽  
Insurance Coverage ◽  
The United States ◽  
Fertility Treatment ◽  
Success Rates ◽  
Policy And Practice ◽  
Insurance Benefits ◽  
Fertility Treatments ◽  
Financial Pressure ◽  
Double Embryo Transfer

AbstractNearly one in eight infants in the United States is born preterm. A variety of factors are associated with preterm birth, including multiplicity. In the United States fertility treatments are currently associated with high rates of multiplicity, but these rates could be reduced significantly if changes can be made to fertility treatment policy and practice. These include reducing the financial pressure on patients to prioritize pregnancy chances over safety by expanding insurance coverage and altering the way we calculate success rates and insurance benefits so that two consecutive single embryo transfers is equivalent to one double embryo transfer.

“GoFundMe isn’t a Medical Plan”: An Ecological Study of Crowdfunding Insulin Success (Preprint)

2021 ◽  
Author(s):  
Julia E Blanchette ◽  
M.J. Tran ◽  
Ernest G Grigorian ◽  
Eli Iacob ◽  
Linda S Edelman ◽  
...  
Keyword(s):  
United States ◽  
Mixed Methods ◽  
Diabetes Management ◽  
Insurance Coverage ◽  
The United States ◽  
Success Rates ◽  
Factors Associated ◽  
Medication Costs ◽  
Qualitative Thematic Analysis ◽  
Reliable Solution

BACKGROUND Individuals in need of medical care are turning to crowdfunding websites to engage a 'crowd' or group for financial support. In the last decade, access to insulin has decreased considerably for several reasons, including the rising cost of insulin, high-deductible insurance plans and increasing insurance premiums. Many people with diabetes are forced to ration or go without insulin, and are turning to crowdfunding websites to seek financial donations to purchase insulin needed to reduce health risks and mortality, and sustain quality of life. This study aims to explore crowdfunding campaign requests to purchase insulin in the United States. OBJECTIVE To explore crowdfunding campaign requests to purchase insulin in the United States. METHODS In this retrospective, mixed-methods study, we coded the text of “GoFundMe” online crowdfunding campaigns and viral measures (shares, hearts and comments) from February 25 to April 15, 2019. We described campaigns (N = 205) and explored factors associated with campaign success using correlations and qualitative thematic analysis. RESULTS The majority of campaigns were initiated by middle-aged adults (26-64-years) (N = 77, 37.6%), with type 1 diabetes (N = 94, 45.9%) needing funds due to insurance coverage issues (N = 125, 61.0%). Factors associated with campaign success included requests for <$500 (P < .01), and higher viral measures (shares, P = .007; hearts, P < .001; comments, P = .002). Four themes emerged from the campaign text: 1) desire for self-management and survival, 2) diabetes management untenable given insulin access, 3) the aftermath of insulin unaffordability, and 4) privacy issues with crowdfunding. Campaign comments were both supportive (tangible, informational, emotional) and unsupportive (questioned need for campaign, crowdfunding deemed inappropriate). CONCLUSIONS Despite crowdfunding websites being used to support the purchase of insulin, campaigns raise only a fraction of the money requested. Therefore, “GoFundMe” Campaigns are not a reliable solution to obtaining insulin funds in the United States. Applying mixed-methods is effective to analyze online crowdfunding for medication costs such as insulin. However, it is critical for PWD to use resources other than online crowdfunding to access and obtain insulin due to low success rates.

scholarly journals Abortion attempts without clinical supervision among transgender, nonbinary and gender-expansive people in the United States

2021 ◽  
pp. bmjsrh-2020-200966
Author(s):  
Heidi Moseson ◽  
Laura Fix ◽  
Caitlin Gerdts ◽  
Sachiko Ragosta ◽  
Jen Hastings ◽  
...  
Keyword(s):  
United States ◽  
Clinical Supervision ◽  
Online Survey ◽  
Clinical Care ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Physical Trauma ◽  
Abortion Care ◽  
And Gender

BackgroundTransgender, nonbinary and gender-expansive (TGE) people face barriers to abortion care and may consider abortion without clinical supervision.MethodsIn 2019, we recruited participants for an online survey about sexual and reproductive health. Eligible participants were TGE people assigned female or intersex at birth, 18 years and older, from across the United States, and recruited through The PRIDE Study or via online and in-person postings.ResultsOf 1694 TGE participants, 76 people (36% of those ever pregnant) reported considering trying to end a pregnancy on their own without clinical supervision, and a subset of these (n=40; 19% of those ever pregnant) reported attempting to do so. Methods fell into four broad categories: herbs (n=15, 38%), physical trauma (n=10, 25%), vitamin C (n=8, 20%) and substance use (n=7, 18%). Reasons given for abortion without clinical supervision ranged from perceived efficiency and desire for privacy, to structural issues including a lack of health insurance coverage, legal restrictions, denials of or mistreatment within clinical care, and cost.ConclusionsThese data highlight a high proportion of sampled TGE people who have attempted abortion without clinical supervision. This could reflect formidable barriers to facility-based abortion care as well as a strong desire for privacy and autonomy in the abortion process. Efforts are needed to connect TGE people with information on safe and effective methods of self-managed abortion and to dismantle barriers to clinical abortion care so that TGE people may freely choose a safe, effective abortion in either setting.

The Impact of the Affordable Care Act Medicaid Expansions on the Sources of Health Insurance Coverage of Undergraduate Students in the United States

2021 ◽  
pp. 107755872110158
Author(s):  
Priyanka Anand ◽  
Dora Gicheva
Keyword(s):  
United States ◽  
Health Insurance ◽  
Undergraduate Students ◽  
Affordable Care Act ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Percentage Points ◽  
The Affordable Care Act ◽  
Medicaid Expansions

This article examines how the Affordable Care Act Medicaid expansions affected the sources of health insurance coverage of undergraduate students in the United States. We show that the Affordable Care Act expansions increased the Medicaid coverage of undergraduate students by 5 to 7 percentage points more in expansion states than in nonexpansion states, resulting in 17% of undergraduate students in expansion states being covered by Medicaid postexpansion (up from 9% prior to the expansion). In contrast, the growth in employer and private direct coverage was 1 to 2 percentage points lower postexpansion for students in expansion states compared with nonexpansion states. Our findings demonstrate that policy efforts to expand Medicaid eligibility have been successful in increasing the Medicaid coverage rates for undergraduate students in the United States, but there is evidence of some crowd out after the expansions—that is, some students substituted their private and employer-sponsored coverage for Medicaid.

How Does the Inclusion of Twins Conceived via Fertility Treatments Influence the Results of Twin Studies?

2012 ◽  
Vol 15 (6) ◽  
pp. 746-752 ◽  
Author(s):  
S. Alexandra Burt ◽  
Kelly L. Klump
Keyword(s):  
Twin Studies ◽  
The United States ◽  
Fertility Treatment ◽  
State University ◽  
Behavioral Differences ◽  
Vitro Fertilization ◽  
Fertility Treatments ◽  
Control And Prevention ◽  
Twin Families

Rates of twinning have risen dramatically over the last 30 years, from 1 in 53 births in 1980 to 1 in 30 births in 2009 (Martin et al. (January 2012). Three decades of twin births in the United States, 1980–2009. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Health Statistics). This increase is largely attributable to increases in the use of fertility treatments (i.e., ovulation induction and in vitro fertilization) combined with delays in parenthood. Although this increase means that more twins are available for recruitment into twin studies, it also has potential consequences for the heritability estimates obtained in these studies. This study sought to evaluate this possibility, making use of the ongoing Michigan Twins Project (N = 7,261 families with twins aged 3–17 years), an arm of the Michigan State University Twin Registry. Results revealed that, on average, twins conceived via fertility treatments had lower rates of behavior problems than those conceived naturally, although these behavioral differences could be explained largely by demographic and socio-economic differences across the two types of twin families. Twin similarity did not meaningfully differ across fertility treatment status. We thus conclude that estimates of genetic and environmental influences obtained from twin studies over the last 10–15 years are more or less unaffected by the inclusion of twins conceived via fertility treatments in their samples.

scholarly journals Union Effects on Health Insurance Provision and Coverage in the United States

ILR Review ◽  
2002 ◽  
Vol 55 (4) ◽  
pp. 610-627 ◽  
Author(s):  
Thomas C. Buchmueller ◽  
John Dinardo ◽  
Robert G. Valletta
Keyword(s):  
United States ◽  
Health Insurance ◽  
Survey Data ◽  
Insurance Coverage ◽  
Health Benefits ◽  
Union Density ◽  
Health Insurance Coverage ◽  
The United States ◽  
Health Coverage ◽  
Private Sector Union

During the past two decades, union density has declined in the United States and employer provision of health benefits has changed substantially in extent and form. Using individual survey data spanning the years 1983–97 combined with employer survey data for 1993, the authors update and extend previous analyses of private-sector union effects on employer-provided health benefits. They find that the union effect on health insurance coverage rates has fallen somewhat but remains large, due to an increase over time in the union effect on employee “take-up” of offered insurance, and that declining unionization explains 20–35% of the decline in employee health coverage. The increasing union take-up effect is linked to union effects on employees' direct costs for health insurance and the availability of retiree coverage.

scholarly journals Maternity Care Preferences for Future Pregnancies Among United States Childbearers: The Impacts of COVID-19

2021 ◽  
Vol 6 ◽  
Author(s):  
Theresa E. Gildner ◽  
Zaneta M. Thayer
Keyword(s):  
United States ◽  
Maternity Care ◽  
Community Care ◽  
Insurance Coverage ◽  
The United States ◽  
Care Needs ◽  
Perceived Safety ◽  
Predominately White ◽  
Centered Care ◽  
Future Care

The COVID-19 pandemic has impacted maternity care decisions, including plans to change providers or delivery location due to pandemic-related restrictions and fears. A relatively unexplored question, however, is how the pandemic may shape future maternity care preferences post-pandemic. Here, we use data collected from an online convenience survey of 980 women living in the United States to evaluate how and why the pandemic has affected women’s future care preferences. We hypothesize that while the majority of women will express a continued interest in hospital birth and OB/GYN care due to perceived safety of medicalized birth, a subset of women will express a new interest in out-of-hospital or “community” care in future pregnancies. However, factors such as local provider and facility availability, insurance coverage, and out-of-pocket cost could limit access to such future preferred care options. Among our predominately white, educated, and high-income sample, a total of 58 participants (5.9% of the sample) reported a novel preference for community care during future pregnancies. While the pandemic prompted the exploration of non-hospital options, the reasons women preferred community care were mostly consistent with factors described in pre-pandemic studies, (e.g. a preference for a natural birth model and a desire for more person-centered care). However, a relatively high percentage (34.5%) of participants with novel preference for community care indicated that they expected limitations in their ability to access these services. These findings highlight how the pandemic has potentially influenced maternity care preferences, with implications for how providers and policy makers should anticipate and respond to future care needs.

End-of-Life Care for an Undocumented Mexican Immigrant

2018 ◽  
Vol 33 (2) ◽  
pp. 63-64 ◽  
Author(s):  
Lilit Karapetyan ◽  
Om Dawani ◽  
Heather S. Laird-Fick
Keyword(s):  
United States ◽  
End Of Life ◽  
Health Care Access ◽  
Limited English Proficiency ◽  
Undocumented Immigrants ◽  
Insurance Coverage ◽  
Poverty Line ◽  
The United States ◽  
Immigrant Population ◽  
Long Term Treatment

The immigrant population in the United States has grown over the past years. Undocumented immigrants account for 14.6% of the uninsured population in the United States. Decisions about end-of-life treatment are often difficult to reach in the best of situations. We present a 43-year-old undocumented Mexican female immigrant with metastatic sarcomatoid squamous cell cervical cancer and discuss the barriers that she faced during her treatment. Limited English proficiency, living below the poverty line, low level of education, and lack access to Medicare, Medicaid, or other insurance coverage under the Affordable Care Act are major causes of decreased health-care access and service utilization by the immigrant population. Latinos are less likely to be referred to hospice by oncologists, and nearly a third of hospice agencies offer limited or no services to undocumented immigrants. Undocumented immigrants with terminal diagnoses generally do not have access to comprehensive or multidisciplinary follow-up treatment. Instead, one of their few options is to return to their home countries without any long-term treatment. This article discusses the many barriers and proposes areas for reform.

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