scholarly journals The impact of the Affordable Care Act on patient coverage and access to care: perspectives from FQHC administrators in Arizona, California and Texas

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Angelo Ercia
Keyword(s):  
Access To Care ◽  
Affordable Care Act ◽  
Health Care Services ◽  
Healthcare Services ◽  
Structured Interviews ◽  
Care Services ◽  
Healthcare Needs ◽  
The Affordable Care Act ◽  
Insured Patients ◽  
The Impact

Abstract Background The Affordable Care Act (ACA) enabled millions of people to gain coverage that was expected to improve access to healthcare services. However, it is unclear the extent of the policy’s impact on Federally Qualified Health Centers (FQHC) and the patients they served. This study sought to understand FQHC administrators’ views on the ACA’s impact on their patient population and organization. It specifically explores FQHC administrators’ perspective on 1) patients’ experience with gaining coverage 2) their ability to meet patients’ healthcare needs. Methods Twenty-two semi-structured interviews were conducted with administrators from FQHCs in urban counties in 2 Medicaid-expanded states (Arizona and California) and 1 non-expanded state (Texas). An inductive thematic analysis approach was used to analyze the interview data. Results All FQHC administrators reported uninsured patients were more likely to gain coverage from Medicaid than from private health insurance. Insured patients generally experienced an improvement in accessing healthcare services but depended on their plan’s covered services, FQHCs’ capacity to meet demand, and specialist providers’ willingness to accept their coverage type. Conclusion Gaining coverage helped improved newly insured patients’ access to care, but limitations remained. Additional policies are required to better address the gaps in the depth of covered services in Medicaid and the most affordable PHI plans and capacity of providers to meet demand to ensure beneficiaries can fully access the health care services they need.

scholarly journals Access and participation: What factors influence the provision and utilisation of health care services by children with learning disabilities?

2017 ◽  
Vol 41 (S1) ◽  
pp. S452-S452
Author(s):  
A. Rebowska
Keyword(s):  
Health Care ◽  
Learning Disabilities ◽  
Young People ◽  
Intellectual Disabilities ◽  
Health Care Services ◽  
Healthcare Services ◽  
Children And Young People ◽  
Care Services ◽  
Healthcare Needs ◽  
Wide Range

AimsThe aim of this literature review is to explore the range of factors that influence the degree of access to health care services by children and young people with learning disabilities.BackgroundChildren with learning disabilities are at increased risk of a wide range of health conditions comparing with their peers. However, recent reports by UK government as well as independent charities working with children and young people with learning disabilities demonstrated that they are at risk of poor health outcomes as a result of barriers preventing them from accessing most appropriate services.MethodsComprehensive searches were conducted in six databases. Articles were also obtained through review of references, a search of the grey literature, and contacting experts in the field. The inclusion criteria were for studies evaluating access to healthcare services, identification and communication of health needs, organisational aspects impacting on access and utilisation, staff attitudes where they impacted on access, barriers, discrimination in patients with intellectual disabilities age 0–18. The literature search identified a sample of 36 papers. The marked heterogeneity of studies excluded conducting a meta-analysis.ResultsBarriers to access included problems with identification of healthcare needs by carers and healthcare professionals, communication difficulties, the inadequacy of facilities, geographical and physical barriers, organisational factors such as inflexible appointment times, attitudes and poor knowledge base of healthcare staff.ConclusionThe factors identified can serve as a guide for managers and clinicians aiming to improve access to their healthcare services for children and young people with intellectual disabilities.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Impact of Insurance Expansions on the Already Insured: The Affordable Care Act and Medicare

2020 ◽  
Vol 12 (4) ◽  
pp. 288-318
Author(s):  
Colleen M. Carey ◽  
Sarah Miller ◽  
Laura R. Wherry
Keyword(s):  
Access To Care ◽  
Affordable Care Act ◽  
Medicare Beneficiaries ◽  
Medicare Population ◽  
Large Panel ◽  
The Affordable Care Act ◽  
The Impact ◽  
Medicaid Expansions ◽  
Rule Out

Some states have not adopted the Affordable Care Act (ACA) Medicaid expansions due to concerns that the expansions may impair access to care and utilization for those who are already insured. We investigate such negative spillovers using a large panel of Medicare beneficiaries. Across many subgroups and outcomes, we find no evidence that the expansions reduced utilization among Medicare beneficiaries and can rule out all but very small changes in utilization or spending. These results indicate that the expansions in Medicaid did not impair access to care or utilization for the Medicare population. (JEL G22, H51, I13, I18, I38)

scholarly journals Access to Health Care Services by Individuals Who Are Deaf or Hard of Hearing (Dhh) in Botswana: Francistown and Tati

2020 ◽  
Author(s):  
Gorgeous Sarah Chinkonono ◽  
Vivian Namuli ◽  
Catherine Atuhaire ◽  
Hamida Massaquoi ◽  
Sourav Mukhopadhyay ◽  
...  
Keyword(s):  
Health Care ◽  
Hard Of Hearing ◽  
Access To Health Care ◽  
Health Care Services ◽  
Healthcare Professionals ◽  
Healthcare Services ◽  
Structured Interview ◽  
Care Services ◽  
Main Challenge ◽  
The Impact

Abstract Background: Individuals who are Deaf or hard of hearing (DHH) face a lot of challenges when accessing health care services. The main barrier that they face is communication. Despite this, not much research had been carried out in Africa to understand how individuals who are DHH access healthcare services. This study sought to explore experiences of individuals who are DHH in Botswana when accessing healthcare services to propose recommendations towards improving their situation.Methods: This is a qualitative research study using phenomenological approach. Participants were observed at one point in time. Face-to-face in-depth interviews were conducted with 22 DHH individuals living in Francistown and Tati, using a semi-structured interview guide and an interpreter. Participants age range was between 18years to 40years. Purposive sampling and snowballing sampling techniques were used to select the participants.Results: The main challenge that individuals who are DHH in Botswana face is communication barrier which has culminated in their reception of poor healthcare services as the healthcare professionals fail to effectively attain to their health needs. This is evident through wrong prescriptions and treatment; poor counselling services, lack of confidentiality; poor maternal health services especially during child delivery; and limited health information. However, individuals who are DHH in Botswana continues to utilise healthcare services.Conclusion: Poor communication between healthcare professionals and individuals who are DHH act as an impediment to acquiring proper healthcare services by individuals who are DHH. This can lead to poor health outcomes for the DHH population as they are not well informed about health issues that they are at risk of and at times do not know where to seek specific healthcare services pertaining to the health problems they are experiencing. Therefore, there is a need to provide sign language interpreters in the healthcare centres to reduce the impact of this problem.

scholarly journals Impact of Language Barriers on Access to Healthcare Services by Immigrant Patients: A systematic review

2020 ◽  
Vol 15 (1) ◽  
pp. 35-48 ◽  
Author(s):  
Sasan Rasi
Keyword(s):  
Health Care ◽  
Access To Care ◽  
Language Proficiency ◽  
Access To Health Care ◽  
Health Care Services ◽  
Language Barriers ◽  
Healthcare Services ◽  
Access To Healthcare ◽  
Native People ◽  
The Impact

Background: Research has demonstrated lower access to healthcare services by immigrant patients in comparison to native people. Cultural and linguistic differences have been considered as main factors that impede this access and as barriers to creating an effective relationship between immigrant patients and health professionals.  Objective: The aim of this study was to better understand and synthesize the available evidence regarding the impact of immigrant patients’ language proficiency on access to health care. Methods: A systematic literature search was performed to identify studies published between January 2000 and January 2019 that examined the impact of language proficiency on access to and use of health services by immigrant patients. Only articles in English were included. Cross-referencing of the identified articles was also performed.  Results: A total of 140 publications was identified through online databases. In all 24 studies were reviewed, and the results were reported using four interrelated themes identified from the articles. These reports consistently showed a clear association between inadequate language ability and underuse of health care services, ineffective communication, and increased use of emergency care by immigrant patients. Identifying factors that can influence access to care, applying immigrant-friendly solutions such as provision of professional interpreters, and encouraging culturally and linguistically sensitive education may improve the quality of care and increase access to care. One study recommended utilisation of communication technologies such as telemedicine to bridge the communication gap and increase accessibility of healthcare services by immigrant patients.  Conclusions: All included studies indicated that language barriers hindered access to healthcare services. The data resulting from this study can update policy and practical solutions for language barriers on access to care by immigrant patients and provide an agenda for further investigations. 

Stabilizing and Strengthening the Affordable Care Act: Opportunities for a New Administration

2021 ◽  
Author(s):  
Stacey McMorrow
Keyword(s):  
Health Care ◽  
Affordable Care Act ◽  
Health Care Access ◽  
Health Care Services ◽  
Federal Law ◽  
The Past ◽  
Care Access ◽  
Care Services ◽  
The Affordable Care Act ◽  
The Law

Abstract Over the past decade, the Affordable Care Act (ACA) has successfully reduced uninsurance and improved access to and affordability of health care services for millions of Americans. But the law has been weakened over the past four years as the Trump administration shortened the open enrollment period in the federal Marketplace, reduced outreach and enrollment funding, and revised the public charge rule, among other actions. The incoming Biden administration will have the chance to reverse some of these changes and further strengthen the law to improve health care access and affordability. In this paper, I explore options to expand access to affordable coverage and care for those who do not qualify for Medicaid or Marketplace financial assistance, and further discuss opportunities to increase enrollment among those who are already eligible. I also examine opportunities to expand access to specific services, including reproductive health care, among those with insurance. Any attempts to modify or build upon the ACA will likely be complicated by the ongoing coronavirus pandemic as well as a divided Congress, but regulatory solutions will likely be easier to achieve than those that require changes to federal law or state policy.

PP090 Reducing Low-Value Practices In Catalonia: Essencial Project

2017 ◽  
Vol 33 (S1) ◽  
pp. 112-113
Author(s):  
Cari Almazan ◽  
Johanna Caro
Keyword(s):  
Primary Care ◽  
Health Care Services ◽  
Implementation Process ◽  
Healthcare Services ◽  
Care Level ◽  
Primary Care Level ◽  
Care Services ◽  
Baseline Status ◽  
The Impact

INTRODUCTION:In 2013 the Essencial Project launched in Catalonia promotes the identification of low-value practices (LVP) by healthcare professionals and elaborates recommendations to avoid them. This project aims to reduce unnecessary care of health care services which harm outweighs the benefits, resulting in physical, psychological to the patients and wasteful healthcare services. The main objectives are to describe the implementation process at the primary care level and to evaluate the impact of recommendations on general practitioners (GPs) practice.METHODS:The implementation process consists in:(i) Nomination of clinical leaders to promote the project among their primary care teams (PCT) and to lead the implementation activities by identification of barriers and enablers for change in clinical practice towards avoiding LVP.(ii) Selection of recommendations to be implemented and definition of corresponding activities to be carried out by each PCT according to the specific characteristics of their organizations.(iii) Development of related indicators and comparison between baseline statusRESULTS:One hundred and sixteen PCT (covering 30 percent of the Catalan population) participated in the pilot experience of implementation. Twenty-one recommendations were selected such as: bisphosphonates in post-menopausal women with low risk of fracture, PSA screening and statins for primary prevention of cardiovascular disease, among others. At 12 month follow-up, use of bisphosphonates were reduced by 21 percent (p = .0005), PSA was reduced by 14 percent (p = .0009). The use of other treatments such as antidepressants, benzodiazepines for some specific clinical conditions decreases with no statistically significant changes.CONCLUSIONS:This is the first experience in Catalonia and Spain of implementation of the recommendations to avoid LVP with early involvement of target professionals. Follow-up results provide information about the early impact of recommendations at primary care level. Our challenge is to implement the recommendations at hospital level.

scholarly journals Access to care among children with disabilities enrolled in the MassHealth CommonHealth Buy-In program

2018 ◽  
Vol 23 (1) ◽  
pp. 6-19 ◽  
Author(s):  
Melissa Hirschi ◽  
Angela Wangari Walter ◽  
Kasey Wilson ◽  
Kate Jankovsky ◽  
Beth Dworetzky ◽  
...  
Keyword(s):  
Access To Care ◽  
Health Care Services ◽  
Qualitative Data ◽  
Children With Disabilities ◽  
Family Income ◽  
Care Services ◽  
Medicaid Eligibility ◽  
The Impact ◽  
Out Of Pocket Costs ◽  
Parents And Caregivers

Children with disabilities utilize more health-care services and incur higher costs than other children do. Medicaid Buy-In programs for children with disabilities have the potential to increase access to benefits while reducing out-of-pocket costs for families whose income exceeds Medicaid eligibility. This study sought to understand how parents and caregivers of Massachusetts children with disabilities perceive access to care under CommonHealth, Massachusetts’s Medicaid Buy-In program. Parents and caregivers ( n = 615) whose children were enrolled in CommonHealth participated in a survey assessing the impact of the program. Qualitative data were coded across five access domains—availability, accessibility, accommodation, affordability, and acceptability. Data suggest that CommonHealth improves access to care for children with disabilities by providing the benefits that were limited in scope or unavailable through other insurance before enrollment and by making available services more affordable. Policy and administrative changes could improve the program and further increase access to care for children with complex, costly conditions. Adopting a Medicaid Buy-In program may be an effective way for states to create a pathway to Medicaid for children with disabilities whose family income is too high for Medicaid and who have unmet needs and/or whose families incur high out-of-pocket costs for their care.

Ten Years Later: Reflections on Critics' Worst-Case Scenarios for the Affordable Care Act

2020 ◽  
Vol 45 (4) ◽  
pp. 465-483
Author(s):  
Stacey McMorrow ◽  
Linda J. Blumberg ◽  
John Holahan
Keyword(s):  
Health Insurance ◽  
Affordable Care Act ◽  
Health Care Services ◽  
Insurance Coverage ◽  
Health Spending ◽  
Health Insurance Coverage ◽  
Worst Case ◽  
Care Services ◽  
Health Insurance Markets ◽  
The Affordable Care Act

Abstract The primary goals of the Affordable Care Act (ACA) were to increase the availability and affordability of health insurance coverage and thereby improve access to needed health care services. Numerous studies have overwhelmingly confirmed that the law has reduced uninsurance and improved affordability of coverage and care for millions of Americans. Not everyone believed that the ACA would lead to positive outcomes, however. Critics raised numerous concerns in the years leading up to the law's passage and full implementation, including about its consequences for national health spending, labor supply, employer health insurance markets, provider capacity, and overall population health. This article considers five frequently heard worst-case scenarios related to the ACA and provides research evidence that these fears did not come to pass.

scholarly journals Impact of Caregiving for Dementia Patients on Healthcare Utilization of Caregivers

Pharmacy ◽  
2019 ◽  
Vol 7 (4) ◽  
pp. 138 ◽  
Author(s):  
Ateequr Rahman ◽  
Rubeena Anjum ◽  
Yelena Sahakian
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Healthcare Services ◽  
Control Group ◽  
Services Utilization ◽  
Care Services ◽  
Dementia Patients ◽  
People With Dementia ◽  
Health Care Services Utilization ◽  
The Impact

The elderly, whom are vulnerable to the physical, mental and chronic diseases of aging, are the fastest growing segment of the US population. Dementia is of particular concern in this population, and caregivers of people with dementia are subjected to psychological, physical, emotional and functional stress. The purpose of this study was to investigate the impact of caregiving for dementia patients on health care services utilization of caregivers and to examine if caregivers utilize more healthcare services than the control group. The study recruited a total of 143 people in control and non-control groups through non-probability convenience sampling. The control group (non-caregivers) comprised of 71 people, whereas the experimental group (caregivers) consisted of 72 participants. The focus of the study was the health care utilization questionnaire, asking the caregiver about the frequency of specific health care services utilization—including medication use in the last six months, on the scale from 0 to 10. Results were statistically significant for each of the healthcare service utilization when comparing caregivers to the control group. By providing adequate support and assistance in form of support groups, we can alleviate caregivers’ burden and more effectively address the needs of caregivers—thereby reducing the utilization of healthcare services.

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