Access to Care for Low-Income Women: The Impact of Medicaid

Women’s sole internal migration has been mostly ignored in migration studies, and the concentration on migrant women has been almost exclusively on low-income women within the household framework. This study focuses on middleclass women’s contemporary rural-urban migration in Lebanon. It probes into the determinants and outcomes of women’s sole internal migration within the empowerment framework. The study delves into the interplay of the personal, social, and structural factors that determine the women’s rural-urban migration as well as its outcomes. It draws together the lived experiences of migrant women to explore the determinants of women’s internal migration as well as the impact of migration on their expanded empowerment.

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How the ‘plates’ of a health system can shift, change and adjust during economic recessions. A qualitative interview study of public and private health providers in Brazil’s São Paulo and Maranhão states

10.31235/osf.io/qtgux ◽

2020 ◽

Author(s):

Giuliano Russo ◽

Maria Luiza Levi Paim ◽

Maria Teresa Seabra Soares de Britto e Alves ◽

Bruno Luciano Carneiro Alves de Oliveira ◽

Ruth Helena de Souza Britto Ferreira de Carvalho ◽

...

Keyword(s):

Health System ◽

Access To Care ◽

Health Systems ◽

Low Income ◽

Sao Paulo ◽

São Paulo ◽

Public And Private ◽

Qualitative Interview Study ◽

Economic Recessions ◽

The Impact

Background. Economic recessions carry an impact on population health and access to care; less is known on how health systems adapt to the conditions brought by a downturn. This particularly matters now that the COVID-19 epidemic is putting health systems under stress. Brazil is one of the world’s most affected countries, and its health system was already living the aftermath of the 2015 recession. Methods. Between 2018 and 2019 we conducted 46 semi-structured interviews with health practitioners, managers and policy-makers to explore the impact of the 2015 recession on public and private providers in prosperous (São Paulo) and impoverished (Maranhão) states in Brazil. Thematic analysis was employed to identify drivers and consequences of system adaptation and coping strategies. Nvivo software was used to aid data collection and analysis. We followed the Standards for Reporting Qualitative Research to provide an account of the findings.Results. We found the concept of ‘health sector crisis’ to be politically charged among healthcare providers in São Paulo and Maranhão. Contrary to expectations, the public sector was reported to have found ways to compensate for diminishing federal funding, having outsourced services and adopted flexible – if insecure – working arrangements. Following a drop in employment and health plans, private health insurance companies streamlined their offer, at times at the expenses of coverage. Low-cost walk-in clinics were hit hard by the recession, but also credited for having moved to cater for higher-income customers in Maranhão.Conclusions. The ‘plates’ of a health system may shift and adjust in unexpected ways in response to recessions, and some of these changes might outlast the crisis. As low-income countries enter post-COVID recessions, it will be important to monitor the adjustments taking place in health systems, to ensure that past gains in access to care and job security are not eroded.

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The Impact of a Prenatal Education Video on Rates of Breastfeeding Initiation and Exclusivity during the Newborn Hospital Stay in a Low-income Population

Journal of Human Lactation ◽

10.1177/0890334415599402 ◽

2015 ◽

Vol 32 (1) ◽

pp. 152-159 ◽

Cited By ~ 16

Author(s):

Ann L. Kellams ◽

Kelly K. Gurka ◽

Paige P. Hornsby ◽

Emily Drake ◽

Mark Riffon ◽

...

Keyword(s):

Hospital Stay ◽

Low Income ◽

Low Cost ◽

Educational Interventions ◽

Breastfeeding Initiation ◽

Prenatal Education ◽

Low Income Population ◽

Breastfeeding Rates ◽

Low Income Women ◽

The Impact

Background: Guidelines recommend prenatal education to improve breastfeeding rates; however, effective educational interventions targeted at low-income, minority populations are needed as they remain less likely to breastfeed. Objective: To determine whether a low-cost prenatal education video improves hospital rates of breastfeeding initiation and exclusivity in a low-income population. Methods: A total of 522 low-income women were randomized during a prenatal care visit occurring in the third trimester to view an educational video on either breastfeeding or prenatal nutrition and exercise. Using multivariable analyses, breastfeeding initiation rates and exclusivity during the hospital stay were compared. Results: Exposure to the intervention did not affect breastfeeding initiation rates or duration during the hospital stay. The lack of an effect on breastfeeding initiation persisted even after controlling for partner, parent, or other living at home and infant complications (adjusted odds ratio [OR] = 1.05, 95% CI, 0.70-1.56). In addition, breastfeeding exclusivity rates during the hospital stay did not differ between the groups ( P = .87). Conclusion: This study suggests that an educational breastfeeding video alone is ineffective in improving the hospital breastfeeding practices of low-income women. Increasing breastfeeding rates in this at-risk population likely requires a multipronged effort begun early in pregnancy or preconception.

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“5-a-day” - What is the Impact on Low Income Women?

Journal of the American Dietetic Association ◽

10.1016/s0002-8223(97)00450-1 ◽

1997 ◽

Vol 97 (9) ◽

pp. A37

Author(s):

S.F. Stallings ◽

P.G. Wolman ◽

C.H. Goodner ◽

S.L. Meacham

Keyword(s):

Low Income ◽

Low Income Women ◽

The Impact

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The Impact of Home Visits on Enrollment Patterns in Pregnancy-Related Services among Low-Income Women

Public Health Nursing ◽

10.1111/j.1525-1446.1994.tb00204.x ◽

1994 ◽

Vol 11 (6) ◽

pp. 392-398 ◽

Cited By ~ 24

Author(s):

Patricia J. Bradley ◽

Joanne Martin

Keyword(s):

Low Income ◽

Home Visits ◽

Related Services ◽

Enrollment Patterns ◽

Low Income Women ◽

The Impact ◽

In Pregnancy

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Modifying physical activity in a multiethnic sample of low-income women: One-year results from the IMPACT (Increasing Motivation for Physical ACTivity) project

Annals of Behavioral Medicine ◽

10.1207/s15324796abm3003_3 ◽

2005 ◽

Vol 30 (3) ◽

pp. 191-200 ◽

Cited By ~ 74

Author(s):

Cheryl L. Albright ◽

Leslie Pruitt ◽

Cynthia Castro ◽

Alma Gonzalez ◽

Sandi Woo ◽

...

Keyword(s):

Physical Activity ◽

Low Income ◽

Low Income Women ◽

One Year ◽

The Impact ◽

Multiethnic Sample

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The Impact of Payer Status on Hospital Admissions: Evidence from an Academic Medical Center

10.21203/rs.3.rs-384429/v1 ◽

2021 ◽

Author(s):

Yanying Zhao ◽

Ioannis Ch. Paschalidis ◽

Jianqiang Hu

Keyword(s):

Access To Care ◽

Low Income ◽

Hospital Admissions ◽

Medical Center ◽

Conditional Logistic Regression ◽

Private Insurance ◽

Academic Medical Center ◽

Safety Net ◽

Safety Net Hospital ◽

The Impact

Abstract Background: Inequity exists in accessing to care for patients with different payer statuses. However, there are few studies on the difference of hospital admissions. This study aims to examine how the payer status affects patients hospitalization from the perspective of a safety-net hospital. Methods: We extracted all patients with visiting record in this medical center between 5/1/2009-4/30/2014, and then linked the outpatient and inpatient records three year before target admission time to patients. We conduct a retrospective observational study using a conditional logistic regression methodology. To control the illness of patients with different diseases in training the model, we construct a three-dimension variable with data stratification technology. The model is validated on a dataset distinct from the one used for training. Results: Payer status is strongly associated with a patient’s admission. Patients covered by private insurance or uninsured are less likely to be admitted than those totally or partially insured by government. For uninsured patients, inequity in access to hospitalization is observed. Among all non-clinical influential factors considered in our study, payer status is a significant important factor. Conclusion: Attention is needed on improving the access to care for vulnerable (low-income) patients, for example, by actively advertising free care programs, reaching out to community organizations with better access to these individuals, or offering assurances that access to care is not linked to immigration procedures. Also, in order to reduce preventable admissions, basic preventive care services should be enhanced.

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Understanding the impact of COVID-19 on the colorectal cancer community: Barriers and opportunities for care.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.3_suppl.29 ◽

2021 ◽

Vol 39 (3_suppl) ◽

pp. 29-29

Author(s):

Reese Garcia ◽

Andrea Dwyer ◽

Molly McDonnell

Keyword(s):

Colorectal Cancer ◽

Focus Groups ◽

Access To Care ◽

Cancer Patients ◽

Low Income ◽

Primary Concern ◽

The Novel ◽

Care Providers ◽

Novel Coronavirus ◽

The Impact

29 Background: The novel coronavirus (COVID-19) has caused numerous disruptions across the cancer prevention and treatment landscape. Conservative modeling studies examining the effect of COVID-19 on cancer screening and treatment for breast and colorectal cancer (CRC) suggest that there will be 10,000 excess deaths from both cancers combined over the next decade. The goal of this analysis was to better understand the impact of COVID-19 on the CRC community, including gaps and opportunities for improving access to care and survivorship needs, and to advocate for the best possible care through policy, education and engagement of the entire cancer ecosystem. Methods: In April 2020, Fight Colorectal Cancer (Fight CRC) distributed an online survey to the colorectal cancer community. The survey was distributed through social media channels and targeted emails from April 24-May 5, 2020. Virtual focus groups were also conducted to gather rich qualitative data from cancer patients and caregivers about their experiences during the novel coronavirus pandemic. Results: In total, 222 individuals responded to the survey (survivors = 68%, caregiver = 12%, first degree family member = 8%, other = 8%), and 10 CRC survivors participated in focus groups (stage III = 30%, stage IV = 70%). Treatment disruptions and mental health were prevalent themes in both the survey and focus group. Over one-third of survey respondents indicated facing treatment disruptions (37%) and a majority (78%) of colorectal cancer patients reported feeling nervous and anxious. Another primary concern among respondents was access to care. Patients on Medicare were more likely than patients on private insurance to report having difficulties affording food and basic supplies. People living in rural areas were more likely to have greater concerns about maintaining a supportive network than those living in suburban areas. Conclusions: People with cancer face unique challenges as a result of the novel coronavirus, including treatment disruptions, increased feelings of anxiety, and financial concerns. Numerous health inequities also exist among low-income and rural patient groups. Identifying the barriers that patients face provides an opportunity to address the nuanced needs of the colorectal cancer community. Clinicians, supportive care providers, and advocacy organizations can tailor care delivery, increase access to care, and prepare patients for the future with reliable and accurate resources amidst a pandemic.

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How did the Affordable Care Act Medicaid Expansion Affect Coverage and Access to Care for Low-Income Parents Who Were Eligible for Medicaid Before the Law Was Passed?

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/00469580211050213 ◽

2021 ◽

Vol 58 ◽

pp. 004695802110502

Author(s):

Stacey McMorrow ◽

Genevieve M. Kenney

Keyword(s):

Access To Care ◽

Low Income ◽

Medicaid Expansion ◽

Eligibility Criteria ◽

Access Problems ◽

Medicaid Eligibility ◽

The Law ◽

Medical Bills ◽

The Impact ◽

Percent Decline

We use the National Health Interview Survey from 2010 to 2017 and a difference-in-differences approach to assess the impact of the Affordable Care Cct (ACA) Medicaid expansion on coverage and access to care for a subset of low-income parents who were already eligible for Medicaid when the ACA was passed. Any gains in coverage would typically be expected to improve access to and affordability of care, but there were concerns that by increasing the total population with coverage and thereby straining provider capacity, that the ACA would reduce access to care for individuals who were already eligible for Medicaid prior to the passage of the law. We found that the expansion reduced uninsurance among previously eligible parents by 12.6 percentage points, or a 40 percent decline from their 2012–2013 uninsurance rate. Moreover, these effects grew stronger over time with a 55 percent decline in uninsurance 2 to 3 years following expansion. Though we identified very few statistically significant impacts of the expansion on affordability of care, descriptive estimates show substantial declines in unmet needs due to cost and problems paying family medical bills. Descriptively, we find no significant increases in provider access problems for previously eligible parents, and very limited evidence that the Medicaid expansion was associated with more constrained provider capacity. Though sample size constraints were likely a factor in our ability to identify impacts on access and affordability measures, our overall findings suggest that the ACA Medicaid expansion positively affected our sample of low-income parents who met pre-ACA Medicaid eligibility criteria.

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