scholarly journals Association of race and health insurance in treatment disparities of colon cancer: A retrospective analysis utilizing a national population database in the United States

PLoS Medicine ◽  
2021 ◽  
Vol 18 (10) ◽  
pp. e1003842
Author(s):  
Scarlett Hao ◽  
Rebecca A. Snyder ◽  
William Irish ◽  
Alexander A. Parikh
Keyword(s):  
United States ◽  
Colon Cancer ◽  
Health Insurance ◽  
Adjuvant Chemotherapy ◽  
Racial Disparities ◽  
Private Insurance ◽  
Insurance Coverage ◽  
The United States ◽  
Treatment Disparities ◽  
To Receive

Background Both health insurance status and race independently impact colon cancer (CC) care delivery and outcomes. The relative importance of these factors in explaining racial and insurance disparities is less clear, however. This study aimed to determine the association and interaction of race and insurance with CC treatment disparities. Study setting Retrospective cohort review of a prospective hospital-based database. Methods and findings In this cross-sectional study, patients diagnosed with stage I to III CC in the United States were identified from the National Cancer Database (NCDB; 2006 to 2016). Multivariable regression with generalized estimating equations (GEEs) were performed to evaluate the association of insurance and race/ethnicity with odds of receipt of surgery (stage I to III) and adjuvant chemotherapy (stage III), with an additional 2-way interaction term to evaluate for effect modification. Confounders included sex, age, median income, rurality, comorbidity, and nodes and margin status for the model for chemotherapy. Of 353,998 patients included, 73.8% (n = 261,349) were non-Hispanic White (NHW) and 11.7% (n = 41,511) were non-Hispanic Black (NHB). NHB patients were less likely to undergo resection [odds ratio (OR) 0.66, 95% confidence interval [CI] 0.61 to 0.72, p < 0.001] or to receive adjuvant chemotherapy [OR 0.83, 95% CI 0.78 to 0.87, p < 0.001] compared to NHW patients. NHB patients with private or Medicare insurance were less likely to undergo resection [OR 0.76, 95% CI 0.63 to 0.91, p = 0.004 (private insurance); OR 0.59, 95% CI 0.53 to 0.66, p < 0.001 (Medicare)] and to receive adjuvant chemotherapy [0.77, 95% CI 0.68 to 0.87, p < 0.001 (private insurance); OR 0.86, 95% CI 0.80 to 0.91, p < 0.001 (Medicare)] compared to similarly insured NHW patients. Although Hispanic patients with private and Medicare insurance were also less likely to undergo surgical resection, this was not the case with adjuvant chemotherapy. This study is mainly limited by the retrospective nature and by the variables provided in the dataset; granular details such as continuity or disruption of insurance coverage or specific chemotherapy agents or dosing cannot be assessed within NCDB. Conclusions This study suggests that racial disparities in receipt of treatment for CC persist even among patients with similar health insurance coverage and that different disparities exist for different racial/ethnic groups. Changes in health policy must therefore recognize that provision of insurance alone may not eliminate cancer treatment racial disparities.

scholarly journals Problems of health insurance coverage and health care in the United States: public and private solution strategies

1992 ◽  
Vol 8 (3) ◽  
pp. 270-286
Author(s):  
E. Richard Brown
Keyword(s):  
United States ◽  
Health Care ◽  
Health Insurance ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Health Care Financing ◽  
Health Insurance Coverage ◽  
The United States ◽  
Political Debate ◽  
Financing System

A nearly universal consensus has developed in the United States that the current health care financing system is a failure. The system has been unable to control the continuing rapid rise in health care costs (by far, the highest in the world), and it has been unable to stem the growing population that has no health insurance coverage (at least 36 million people). There is nearly universal political agreement that government must provide health insurance to a far greater share of the population than ever before. The political debate now focuses on whether this expanded government role should supplement the private insurance system with an enlarged public program covering those left out of private insurance coverage, or replace private insurance with a universal government health insurance program covering the entire population.

scholarly journals Telepsychiatry and Medical Insurance: Comparative Perspectives Between India and the United States

2020 ◽  
Vol 42 (5_suppl) ◽  
pp. 92S-97S
Author(s):  
P Lakshmi Nirisha ◽  
Srinagesh Mannekote Thippaiah ◽  
Rachel E. Fargason ◽  
Barikar C Malathesh ◽  
Narayana Manjunatha ◽  
...  
Keyword(s):  
United States ◽  
Health Insurance ◽  
United States Of America ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Cost Effective ◽  
Health Insurance Coverage ◽  
The United States ◽  
Regulatory Policies ◽  
Cost Effective Alternative

Telepsychiatry is a cost-effective alternative to in-person psychiatric consultations. The COVID-19 pandemic brought about a sharp spike in the utilization of telepsychiatry due to ongoing restrictions on gatherings and traveling. In recognition of the importance of telemedicine in general, and telepsychiatry specifically, telemedicine practice guidelines and telepsychiatry operational guidelines have been released. Due to the rising trend in telemedicine, the Insurance Regulatory and Development Authority of India (IRDIA) incorporated teleconsultation health insurance coverage at a level on par with regular in-person consultations. In contrast, in the United States of America, private insurance coverage for telepsychiatry has been in vogue for some time. In this paper we draw comparisons between India and the United States on telepsychiatry and health insurance. We compare the evolving regulatory policies of these two countries in relation to existing insurances plans that are available, the challenges in implementation of new regulations and the possible ways to overcome the challenges to make telepsychiatry affordable to all.

scholarly journals What Counselors Need to Know About Health Care Reform

2010 ◽  
Vol 43 (1) ◽  
Author(s):  
Scott Barstow
Keyword(s):  
United States ◽  
Health Care ◽  
Health Insurance ◽  
Health Care Services ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Health Sector ◽  
The United States ◽  
Care Services ◽  
The Law

More than 60 years after President Truman wrote those words and nearly 100 years since health insurance was proposed by Teddy Roosevelt, the United States has joined the rest of the developed nations in initiating a health care system aimed at establishing universal insurance coverage. President Barack Obama and his colleagues in the House and Senate succeeded where many, many others failed, but just barely. The legislation, described as "similar in scope to Great Society and New Deal programs," was enacted "without the benefit of the congressional majorities of those eras" (Oberlander, 2010). For some health care advocates, the law was a disappointment, as it missed opportunity to establish a "public option" for health insurance, a publicly financed and operated program similar to Medicare to provide broad coverage. For others, the legislation constituted the transformation of the United States into a socialist state, somehow endangering America's "freedoms." The reality is that the new law keeps the predominant role of private insurance coverage and welds it to a new framework of rules, investments in improving the effectiveness and efficiency of care, and a strengthened public health sector to establish a more rational system. The law will have a significant impact oi:i counselors as both consumers and providers of health care services, and its enactment has implications for counselor advocacy.

scholarly journals What Counselors Need to Know About Health Care Reform

2010 ◽  
Vol 43 (1) ◽  
Author(s):  
Scott Barstow
Keyword(s):  
United States ◽  
Health Care ◽  
Health Insurance ◽  
Health Care Services ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Health Sector ◽  
The United States ◽  
Care Services ◽  
The Law

More than 60 years after President Truman wrote those words and nearly 100 years since health insurance was proposed by Teddy Roosevelt, the United States has joined the rest of the developed nations in initiating a health care system aimed at establishing universal insurance coverage. President Barack Obama and his colleagues in the House and Senate succeeded where many, many others failed, but just barely. The legislation, described as "similar in scope to Great Society and New Deal programs," was enacted "without the benefit of the congressional majorities of those eras" (Oberlander, 2010). For some health care advocates, the law was a disappointment, as it missed opportunity to establish a "public option" for health insurance, a publicly financed and operated program similar to Medicare to provide broad coverage. For others, the legislation constituted the transformation of the United States into a socialist state, somehow endangering America's "freedoms." The reality is that the new law keeps the predominant role of private insurance coverage and welds it to a new framework of rules, investments in improving the effectiveness and efficiency of care, and a strengthened public health sector to establish a more rational system. The law will have a significant impact oi:i counselors as both consumers and providers of health care services, and its enactment has implications for counselor advocacy.

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.

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.

Insurance coverage and care affordability in cancer survivors in 2016-2019.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1520-1520
Author(s):  
Justin Michael Barnes ◽  
Eric Adjei Boakye ◽  
Mario Schootman ◽  
Evan Michael Graboyes ◽  
Nosayaba Osazuwa-Peters
Keyword(s):  
United States ◽  
Cancer Survivors ◽  
Low Socioeconomic Status ◽  
Private Insurance ◽  
Insurance Coverage ◽  
The United States ◽  
Mediating Effect ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Linear Probability

1520 Background: The Affordable Care Act (ACA) led to improvements in insurance coverage and care affordability in cancer patients. However, the uninsured rate for the general US reached its nadir in 2016 and has been increasing since. We aimed to quantify the changes in insurance coverage and rate of care unaffordability in cancer survivors from 2016 to 2019. Methods: We queried data from the Behavioral Risk Factor Surveillance System (2016-2019) for cancer survivors ages 18-64 years. Outcomes of interest were the percentage of cancer survivors reporting insurance coverage and the percentage reporting cost-driven lack of care in the previous 12 months. Survey-weighted linear probability models adjusted for covariates (age, sex, race/ethnicity, income, education, marital status, and state Medicaid expansion status) were utilized to estimate the average yearly change (AYC) in the outcomes across 2016-2019. Mediation analyses evaluated the mediating effect of insurance coverage changes on changes in cost-driven lack of care. Results: A total of 178,931 cancer survivors were identified among the survey respondents. The percentage of insured cancer survivors between 2016 and 2019 decreased from 92.4% to 90.4% (AYC: -0.54, 95% CI = -1.03 to -0.06, P =.026). This translates to an estimated 164,638 cancer survivors in the United States who lost insurance coverage in the study period. There were decreases in private insurance coverage (AYC: -1.66, 95% CI = -3.1 to -0.22, P =.024) but increases in Medicaid coverage (AYC: 1.14, 95% CI = 0.03 to 2.25, P =.043). The decreases in any coverage were largest in individuals with income < 138% federal poverty level (FPL) (AYC: -1.14, 95% CI = -2.32 to 0.04, P =.059; compared to > 250% FPL, Pinteraction=.03). Cost-driven lack of care in the preceding 12 months among cancer survivors increased from 17.9% in 2016 to 20% in 2019 (AYC: 0.67, 95% CI = 0.06 to 1.27, P =.03), which translates to an estimated 167,184 survivors in the US who skipped care due to costs. Changes in insurance coverage mediated 27.5% of the observed change in care unaffordability overall (p =.028) and 65.7% in individuals with income < 138% FPL relative to > 250% FPL (p =.045). Conclusions: Between 2016 and 2019, about 165,000 cancer survivors in the United States lost their insurance coverage and a similar number may have skipped needed care due to cost. Loss of insurance coverage was mostly among individuals with low socioeconomic status. Interventions to improve health insurance coverage among cancer survivors, such as the recent executive order to strengthen the ACA and further efforts promoting Medicaid expansion in additional states, may be important factors to mitigate these trends.

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