scholarly journals A multilevel mixed-effects regression analysis of the association between hospital, community and state regulatory factors, and family income eligibility limits for free and discounted care among U.S. not-for-profit, 501(c)(3), hospitals, 2010 to 2017

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jason N. Mose
Keyword(s):  
Low Income ◽  
Family Income ◽  
Safety Net ◽  
Mixed Effects ◽  
Poverty Level ◽  
Community Factors ◽  
Regulatory Factors ◽  
For Profit ◽  
Community Benefits ◽  
Not For Profit

Abstract Background Not-for-profit hospitals are facing an uncertain financial future, especially following the COVID-19 pandemic. Nevertheless, they are legally obligated to provide free and discounted health care services to communities. This study investigates the hospital, community, and state regulatory factors and whether these factors are associated with family income eligibility levels for free and discounted care. Methods Data were sourced from Internal Revenue Service Form 990, several data files from the Centers for Medicare and Medicaid, demographic and community factors from the Census Bureau, supplemental files from The Hilltop Institute, Community Benefit Insight, and Kaiser Family Foundation. The study employs multilevel mixed-effects linear and ordered logit regressions to estimate the association between the hospital, community, state policies, and the hospital’s family income eligibility limit for free and discounted care. Results A plurality of hospitals (49.96%) offered a medium level of family income eligibility limit (160–200% of the federal poverty level (FPL)) for free care. In comparison, about 53% (52.94%) offered a low level (0–300 of FPL) eligibility limit for discounted care. Holding all else equal, hospitals designated as critical access, safety net, those in rural areas or located in disadvantaged areas were associated with an increased probability of offering low eligibility limits for free and discounted care. Hospitals in a joint venture, located in highly concentrated markets or states with minimum community benefits requirements, were associated with an increased probability of offering high eligibility limits. Conclusion State and community factors appear to be associated with the eligibility level for free and discounted care. Hospitals serving low-income or rural communities seem to offer the least relief. The federal and state policymakers might need to consider relief to these hospitals with a requirement for them to provide a specific set of minimum community benefits.

The Fall of Orchard Park, the Rise of Orchard Gardens

2018 ◽  
pp. 191-229
Author(s):  
Lawrence J. Vale
Keyword(s):  
Public Housing ◽  
Low Income ◽  
Hope Vi ◽  
New School ◽  
For Profit ◽  
Not For Profit ◽  
New Community ◽  
Private Management ◽  
Community Facilities ◽  
Public Housing Residents

Chapter 7 describes the harrowing decline of Orchard Park during the late 1980s and early 1990s and then traces the resident-centered successful effort to transform Orchard Park into Orchard Gardens using the HOPE VI program. When HOPE VI funds became available in the 1990s, activist Boston citizens—prominently including Orchard Park Tenants Association chairwoman Edna Bynoe—had every reason to assume that public housing transformation would overwhelmingly serve those with the lowest incomes. HOPE VI, Boston-style, was co-led by a neighborhood-based not-for-profit developer and featured prominent resident input. Orchard Gardens allocated 85 percent of dwellings to public housing residents, while enabling 70 percent of former Orchard Park households to return. The new community, under well-regarded private management, also positively impacted the surrounding neighborhood by providing infill housing, as well as community facilities, including a new school. Boston continued to emphasize housing for very low-income households in subsequent HOPE VI initiatives.

scholarly journals The social and environmental dimensions of nutrition science

2005 ◽  
Vol 8 (6a) ◽  
pp. 749-752 ◽  
Author(s):  
Massimo Pettoello-Mantovani
Keyword(s):  
Sustainable Development ◽  
Low Income ◽  
Food Policy ◽  
Private Institutions ◽  
Global Issues ◽  
For Profit ◽  
Nutrition Science ◽  
Not For Profit ◽  
Number Of Factors ◽  
The Social

AbstractObjectiveTo emphasise the importance of defining a new nutrition science and food policy that includes social and environmental dimensions.DesignNutrition science and food policy is put in the context of sustainable development. Examples are presented to show that a number of factors including exploitation of resources, disrespect for land and food insecurity contribute to the decline of a culture. The fate of cultures that lack implemented sustainable development strategies is discussed.ConclusionPressure from low-income and economically challenged countries combined with the efforts of not-for-profit private institutions is proposed. The goal is to produce and provide science-based evidence and guidelines to be used as a tool to encourage institutions and organisations to redefine their policies to deal effectively with global issues.

scholarly journals Prevalence and nutritional quality of free food and beverage acquisitions at school and work by SNAP status

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0257879
Author(s):  
Aviva A. Musicus ◽  
Anne N. Thorndike ◽  
Jason P. Block ◽  
Eric B. Rimm ◽  
Sara N. Bleich
Keyword(s):  
Low Income ◽  
Nutritional Quality ◽  
Free Food ◽  
Safety Net ◽  
Healthy Eating Index ◽  
Dietary Quality ◽  
Poverty Level ◽  
Food Acquisition ◽  
Assistance Program

Background The dual burden of poor diet quality and food insecurity makes free food—food acquired at no cost—a very important part of the nutrition safety net for low-income families. The goal of this study was to determine the national prevalence and nutritional quality of free food acquired separately in two settings: 1) by children at school; and 2) by employees at work; both stratified by participation in the Supplemental Nutrition Assistance Program (SNAP). Methods Using National Household Food Acquisition and Purchase Survey data (2012; n = 4,826 U.S. households containing 5,382 employed adults and 3,338 school-aged children), we used survey-weighted proportions to describe free food acquisition and linear regression to compare the 2010 Healthy Eating Index (HEI-2010) for free/non-free food acquisition events (i.e., meals) by SNAP status. Analyses were conducted in 2019–2020. Results SNAP households had more free acquisition events (29.6%) compared to non-SNAP households (<185% federal poverty level (FPL) = 22.3%; ≥185%FPL = 21.0%, p’s<0.001). For SNAP-participant children, free acquisition events at school had a higher mean HEI-2010 compared to non-free acquisition events at school (50.3 vs. 43.8, p = 0.033) and free acquisition events by SNAP-non-participant children ≥185%FPL at school (50.3 vs. 38.0, p = 0.001). Free and non-free acquisition events at work had relatively low HEI-2010s, with no differences by SNAP status. Conclusions Over one fifth of all food acquisition events were free, but free food acquisitions at school and work were relatively unhealthy. For children participating in SNAP, free food acquired at school had higher nutritional quality. Improving the dietary quality of free foods could improve the health of families, especially those participating in SNAP.

scholarly journals Financial Difficulties in Families of Hospitalized Children

2020 ◽  
Vol 15 (11) ◽  
pp. 652-658 ◽  
Author(s):  
Hannah K Bassett ◽  
Ryan J Coller ◽  
Jimmy Beck ◽  
Kevin Hummel ◽  
Kristen A Tiedt ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Low Income ◽  
Financial Distress ◽  
Family Income ◽  
Pediatric Population ◽  
Financial Burden ◽  
Predictor Variable ◽  
Hospitalized Children ◽  
Poverty Level ◽  
Financial Difficulties

BACKGROUND: High costs of hospitalization may contribute to financial difficulties for some families. OBJECTIVE: To examine the prevalence of financial distress and medical financial burden in families of hospitalized children and identify factors that can predict financial difficulties. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional survey of parents of hospitalized children at six children’s hospitals between October 2017 and November 2018. MAIN OUTCOMES AND MEASURES: The outcomes were high financial distress and medical financial burden. Multivariable logistic regression identified predictors of each outcome. The primary predictor variable was level of chronic disease (complex chronic disease, C-CD; noncomplex chronic disease, NC-CD; no chronic disease, no-CD). RESULTS: Of 644 invited participants, 526 (82%) were enrolled, with 125 (24%) experiencing high financial distress, and 160 (30%) reporting medical financial burden. Of those, 86 (54%) indicated their medical financial burden was caused by costs associated with their hospitalized child. Neither C-CD nor NC-CD were associated with high financial distress. Child-related medical financial burden was associated with both C-CD and NC-CD (adjusted odds ratio [AOR], 4.98; 95% CI, 2.41-10.29; and AOR, 2.57; 95% CI, 1.11-5.93), compared to no-CD. Although household poverty level was associated with both measures, financial difficulties occurred in all family income brackets. CONCLUSION: Financial difficulties are common in families of hospitalized children. Low-income families and those who have children with chronic conditions are at particular risk; however, financial difficulties affect all subsets of the pediatric population. Hospitalization may be a prime opportunity to identify and engage families at risk for financial distress and medical financial burden.

Sociodemographic Correlates of Food Insecurity Among New York City Tobacco Users

2020 ◽  
Vol 34 (6) ◽  
pp. 664-667
Author(s):  
Christina N. Wysota ◽  
Scott E. Sherman ◽  
Elizabeth Vargas ◽  
Erin S. Rogers
Keyword(s):  
New York ◽  
New York City ◽  
Food Insecurity ◽  
Low Income ◽  
York City ◽  
Safety Net ◽  
The United States ◽  
United States Department ◽  
Poverty Level ◽  
Sociodemographic Correlates

Purpose: To identify rates and sociodemographic correlates of food insecurity among low-income smokers. Design: Cross-sectional analysis of baseline survey data from a randomized controlled trial (N = 403) testing a smoking cessation intervention for low-income smokers. Setting: Two safety-net hospitals in New York City. Sample: Current smokers with annual household income <200% of the federal poverty level. Measures: Food insecurity was measured using the United States Department of Agriculture 6-item food security module. Participant sociodemographics were assessed by self-reported survey responses. Analysis: We used frequencies to calculate the proportion of smokers experiencing food insecurity and multivariable logistic regression to identify factors associated with being food insecure. Results: Fifty-eight percent of participants were food insecure, with 29% reporting very high food insecurity. Compared to married participants, separated, widowed, or divorced participants were more likely to be food insecure (adjusted odds ratio [AOR] = 2.33, 95% confidence interval [CI]: 1.25-4.33), as were never married participants (AOR = 2.81, 95% CI: 1.54-5.14). Conclusions: Health promotion approaches that target multiple health risks (eg, smoking and food access) may be needed for low-income populations. Interventions which seek to alleviate food insecurity may benefit from targeting socially isolated smokers.

scholarly journals Trends in Cancer Diseases Prevalence by Different Socioeconomic Strata in the United States

2021 ◽  
Author(s):  
Mingsi Wang ◽  
Yi Ma ◽  
Liangru Zhou ◽  
Yi Cheng ◽  
Yue Li ◽  
...  
Keyword(s):  
United States ◽  
Low Income ◽  
Family Income ◽  
Temporal Trends ◽  
The United States ◽  
High Income ◽  
Poverty Level ◽  
Middle Income ◽  
Socioeconomic Strata ◽  
Cancer Diseases

Abstract Background Income disparity among different socioeconomic strata in the United States has widened sharply in recent decades. Take into account the well-established link between income and health, this widening income gap may provide insight into the dynamics of the cancer disease burden in American adults. Assess the temporal trends of the 20-year predicted absolute cancer risk in American adults at different socioeconomic classes. Methods The cross-sectional analyses were carried out using data from adults aged 20 to 85 years between the 1999 and 2018 NHANES. Socioeconomic status was divided into three groups based on the family income to poverty ratio (PIR): high income (PIR ≥ 4), middle income (> 1 and <4), or at or below the federal poverty level (≤ 1). Results The analysis included 49 720 participants. The prevalence of lung cancer was lower in high-income participants than in middle-income participants (0.15% [n= 19] vs 0.35% [n= 92], p <0.001). For the low-income stratum, the prevalence of breast cancer was 1.12% [n = 117], but the number of adults in the middle (1.48% [n = 391], p = 0.009) and high-income levels (1.71% [n = 219], p <0.001) has increased. Conclusions The study found that the prevalence of cancer diseases was increasingly different among participants of different socioeconomic classes of NHANES from 1999 to 2018. Further research is required on the dynamics and health impact of income inequality, as well as public health policies and efforts to reduce these inequalities.

Global Health Disparities: A Pressing Issue and a Student-based Initiative to Help

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
David Ripsman
Keyword(s):  
Developing Countries ◽  
Health Disparities ◽  
Medical Student ◽  
Global Health ◽  
Low Income ◽  
Healthcare Disparities ◽  
Developed Countries ◽  
For Profit ◽  
Not For Profit

Abstract: Developing countries, such as India, suffer profound healthcare disparities compared to developed countries. This commentary explores these healthcare disparities, the barriers to improving healthcare in developing countries, and potential solutions to address these barriers. As an example of a medical student initiative, we highlight a not-for-profit organization that we started with a group of University of Ottawa students, Heart 2 Heart: International Healthcare Relief. Heart 2 Heart provides students at Ontario Universities an opportunity to support the health of low-income individuals in India, Morocco, and Bangladesh.

Generalized Exchange and Public Policy: An Illustration of Support for Public Schools

1998 ◽  
Vol 17 (2) ◽  
pp. 274-286 ◽  
Author(s):  
Kimball P. Marshall
Keyword(s):  
Public Policy ◽  
Public Schools ◽  
Social Responsibility ◽  
Organization Performance ◽  
Exchange System ◽  
For Profit ◽  
Community Benefits ◽  
Not For Profit ◽  
Generalized Exchange ◽  
School Tax

Generalized exchange, or indirect transfers in a univocal exchange system, is not researched widely but is common in situations involving public policies and not-for-profit organizations. Using survey data on support for a school tax, the author assesses the influences of perceptions of community benefits, organization performance, and social responsibility. The results partially support the utility of distinguishing between generalized and restricted exchange situations.

scholarly journals Not-for-profit hospitals’ provision of community benefit during the 2008 recession: An analysis of hospitals in Maryland

2013 ◽  
Vol 3 (3) ◽  
pp. 7
Author(s):  
Simone Rauscher Singh
Keyword(s):  
Burden Of Illness ◽  
Panel Regression ◽  
Charity Care ◽  
Community Benefit ◽  
For Profit ◽  
Community Benefits ◽  
Not For Profit ◽  
Difficult Time ◽  
Using Data ◽  
Charitable Activities

During the 2008 recession, many U.S. hospitals had to lay off staff and cut services to reduce costs, yet little is known about how these cuts affected hospitals’ provision of community benefits. While the need for charitable programs and services grew during this economically difficult time, financial pressures may have forced hospitals to cut back on their community benefit spending. Using data for not-for-profit hospitals in the state of Maryland for the years 2006 to 2010, this study explored whether, and if so how, hospitals changed their provision of community benefit during the 2008 recession. The findings showed that, on average, Maryland hospitals increased their charitable activities during the recent recession. Between 2006 and 2010, total spending on community benefits grew from an average of 5.6% to 7.7% of operating expenses with the most substantial growth in hospitals’ provision of charity care and mission-driven health services. Panel regression analysis showed that this increase in charitable activity was associated with increases in community need. Hospitals’ financial performance, on the other hand, was unrelated to their community benefit spending. These findings indicate that even in times of constrained budgets, Maryland hospitals provided substantial amounts of community benefit in response to the needs of the communities they serve. Hospital-based community benefit programs thus have the potential to play an important role in on-going community-wide efforts aimed at reducing the burden of illness and improving population health.  

scholarly journals Convenience Store Contribution to Adults’ Dietary Intake - What We Eat In America, NHANES, 2013–2016

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1459-1459
Author(s):  
Suzanne Morton ◽  
Alanna Moshfegh ◽  
Donna Rhodes
Keyword(s):  
Dietary Intake ◽  
Energy Intake ◽  
Low Income ◽  
Family Income ◽  
Agricultural Research ◽  
Lower Percentage ◽  
Convenience Store ◽  
United States Department ◽  
Poverty Level ◽  
Convenience Stores

Abstract Objectives Convenience stores account for a small but growing percentage of household packaged food purchases. This research describes the contribution of convenience stores to U.S. adult food and beverage consumption and energy intake. Methods The study included nationally representative data from 9861 adults, 20+ years old (excluding pregnant/lactating women), participating in What We Eat in America, National Health and Nutrition Examination Survey 2013–2016. Dietary intake data, obtained from an in-person 24-hour recall, were collected using an interviewer-administered 5-step USDA Automated Multiple-Pass Method. For each food/beverage reported, participants were asked name of eating occasion, self-selected from a fixed list, and source where the item was obtained. Meal occasions included breakfast, lunch (includes brunch), and dinner (includes supper). Snack occasions included snack, drink, and extended consumption. Eating occasions of only plain water were excluded from analysis. Convenience store source included convenience-type store (e.g., 7–11, Circle K), dollar store, drug store, gas station, gift shop, and liquor/beer store. Differences were considered significant at P &lt; 0.01. Results Overall, 26% of adults consumed a food or beverage obtained from a convenience store on any given day. Males, older adults (&lt;60 years), and low income individuals (family income &lt;131% of poverty level) were more likely to consume a food or beverage from a convenience store. Comparisons among race/ethnicity groups illustrated a greater percentage of non-Hispanic blacks (36%) and a lower percentage of non-Hispanic Asians (13%) consumed an item from a convenience store. Among consumers of food/beverages from convenience stores, 20% of daily energy intake came from convenience store items, with the majority of energy from these items consumed during snack occasions. Conclusions One in four adults obtained at least one food or beverage from a convenience store on any given day, with convenience store consumers having a different demographic profile than non-consumers. This highlights the importance of convenience stores to U.S. dietary intake and need for further research on socio-demographic differences. Funding Sources United States Department of Agriculture, Agricultural Research Service.

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