Medicaid Expansion Under Health Reform May Increase Service Use And Improve Access for Low-Income Adults With Diabetes

2012 ◽  
Vol 31 (1) ◽  
pp. 159-167 ◽  
Author(s):  
Rachel L. Garfield ◽  
Anthony Damico
Keyword(s):  
Low Income ◽  
Health Reform ◽  
Service Use ◽  
Medicaid Expansion ◽  
Improve Access

Medicaid's Role in Health Reform and Closing the Coverage Gap

2016 ◽  
Vol 44 (4) ◽  
pp. 580-584 ◽  
Author(s):  
Diane Rowland ◽  
Barbara Lyons
Keyword(s):  
Health Outcomes ◽  
Affordable Care Act ◽  
Low Income ◽  
Health Reform ◽  
Medicaid Expansion ◽  
Public And Private ◽  
Coverage Gap ◽  
The Poor ◽  
Uninsured Adults ◽  
Improve Access

Medicaid coverage matters for millions of low-income Americans, and especially for those with ongoing and serious health challenges. A source of comprehensive and affordable coverage, Medicaid has long been a cornerstone of federal and state efforts to improve access and health outcomes for very poor and medically vulnerable populations. The Affordable Care Act (ACA) leveraged Medicaid's role in serving the poor to broaden the program's reach to millions of low-income uninsured adults, and positioned the program as a fundamental component of the newly established continuum of public and private coverage. Looking ahead, if more states embrace the Medicaid expansion, there is the potential to build on this progress to significantly reduce the number of uninsured Americans.

Transportation Barriers and Use of Dental Services among Medicaid-Insured Adults

2017 ◽  
Vol 3 (1) ◽  
pp. 101-108 ◽  
Author(s):  
S.C. McKernan ◽  
J.C. Reynolds ◽  
A. Ingleshwar ◽  
M. Pooley ◽  
R.A. Kuthy ◽  
...  
Keyword(s):  
Low Income ◽  
Dental Care ◽  
Behavioral Model ◽  
Medicaid Expansion ◽  
Dental Services ◽  
Dental Utilization ◽  
Access To Dental Care ◽  
Transportation Barriers ◽  
General Dentist ◽  
Improve Access

This study explores how travel distance and other transportation barriers are associated with dental utilization in a Medicaid expansion population. We analyzed data from the Iowa Dental Wellness Plan (DWP), which provides comprehensive dental benefits for low-income adults aged 19 to 64 y as part of Iowa’s Medicaid expansion. Transportation and geographical characteristics were evaluated as enabling factors within the framework of Andersen’s behavioral model of health services use. In March 2015, a random sample of DWP members ( n = 4,800) was surveyed; adjusted survey response rate was 30% ( n = 1,258).The questionnaire was based on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Dental Plan Survey and assessed need for dental care, use of dental services and transportation to visits, and self-perceived oral health status. Respondent and dentist addresses were geocoded and used to calculate distance to the nearest DWP general dentist. A logistic regression model predicting utilization of dental care was developed using variables representing each domain of the behavioral model. Most respondents (57%) reported a dental visit since enrolling. Overall, 11% of respondents reported unmet dental need due to transportation problems. Median distance to the nearest general dentist was 1.5 miles. In the adjusted model, travel distance was not significantly associated with the likelihood of dental utilization. However, other transportation-related issues were significantly associated with utilization, including concern about cost of transportation and driver/passenger status. As concern about transportation cost increased, likelihood of having a dental visit decreased. Targeted approaches to assisting low-income populations with transportation barriers should be considered in designing policies and interventions to improve access to dental care. Knowledge Transfer Statement: The results of this study can be used by policy makers and public health planners when designing programs and interventions to improve access to dental care. Consideration of transportation availability and costs could improve utilization of routine dental care, especially among low-income populations.

Transportation Barriers and Use of Dental Services among Medicaid-Insured Adults

2019 ◽  
Author(s):  
Susan C McKernan ◽  
Julie C Reynolds ◽  
Aparna Ingleshwar ◽  
Mark Pooley ◽  
Raymond A Kuthy ◽  
...  
Keyword(s):  
Low Income ◽  
Dental Care ◽  
Behavioral Model ◽  
Medicaid Expansion ◽  
Dental Services ◽  
Dental Utilization ◽  
Access To Dental Care ◽  
Transportation Barriers ◽  
General Dentist ◽  
Improve Access

This study explores how travel distance and other transportation barriers are associated with dental utilization in a Medicaid expansion population. We analyzed data from the Iowa Dental Wellness Plan (DWP), which provides comprehensive dental benefits for low-income adults aged 19 to 64 y as part of Iowa's Medicaid expansion. Transportation and geographical characteristics were evaluated as enabling factors within the framework of Andersen's behavioral model of health services use. In March 2015, a random sample of DWP members ( n = 4,800) was surveyed; adjusted survey response rate was 30% ( n = 1,258).The questionnaire was based on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Dental Plan Survey and assessed need for dental care, use of dental services and transportation to visits, and self-perceived oral health status. Respondent and dentist addresses were geocoded and used to calculate distance to the nearest DWP general dentist. A logistic regression model predicting utilization of dental care was developed using variables representing each domain of the behavioral model. Most respondents (57%) reported a dental visit since enrolling. Overall, 11% of respondents reported unmet dental need due to transportation problems. Median distance to the nearest general dentist was 1.5 miles. In the adjusted model, travel distance was not significantly associated with the likelihood of dental utilization. However, other transportation-related issues were significantly associated with utilization, including concern about cost of transportation and driver/passenger status. As concern about transportation cost increased, likelihood of having a dental visit decreased. Targeted approaches to assisting low-income populations with transportation barriers should be considered in designing policies and interventions to improve access to dental care. Knowledge Transfer Statement: The results of this study can be used by policy makers and public health planners when designing programs and interventions to improve access to dental care. Consideration of transportation availability and costs could improve utilization of routine dental care, especially among low-income populations.

Comparing shopper characteristics by online grocery ordering use among households in low-income communities in Maine

2021 ◽  
pp. 1-16
Author(s):  
Laura Y. Zatz ◽  
Alyssa J. Moran ◽  
Rebecca L. Franckle ◽  
Jason P. Block ◽  
Tao Hou ◽  
...  
Keyword(s):  
Low Income ◽  
Grocery Shopping ◽  
Sociodemographic Characteristics ◽  
Chi Square ◽  
Transaction Data ◽  
Future Studies ◽  
Number Of Children ◽  
Online Shoppers ◽  
Race Ethnicity ◽  
Improve Access

Abstract Objective: Online grocery shopping could improve access to healthy food, but it may not be equally accessible to all populations—especially those at higher risk for food insecurity. This study aimed to compare the sociodemographic characteristics of families who ordered groceries online versus those who only shopped in-store. Design: We analyzed enrollment survey and 44 weeks of individually-linked grocery transaction data. We used univariate chi-square and t-tests and logistic regression to assess differences in sociodemographic characteristics between households that only shopped in-store and those that shopped online with curbside pick-up (online only or online and in-store). Setting: Two Maine supermarkets. Participants: 863 parents or caregivers of children under 18 years old enrolled in two fruit and vegetable incentive trials Results: Participants had a total of 32 757 transactions. In univariate assessments, online shoppers had higher incomes (P<0.0001), were less likely to participate in WIC or SNAP (P<0.0001), and were more likely to be female (P=0.04). Most online shoppers were 30–39 years old, and few were 50 years or older (P=0.003). After controlling for age, gender, race/ethnicity, number of children, number of adults, income, and SNAP participation, female primary shoppers (OR=2.75, P=0.003), number of children (OR=1.27, P=0.04), and income (OR=3.91 for 186–300% FPL and OR=6.92 for >300% FPL, P<0.0001) were significantly associated with likelihood of shopping online. Conclusions: In this study of Maine families, low-income shoppers were significantly less likely to utilize online grocery ordering with curbside pick-up. Future studies could focus on elucidating barriers and developing strategies to improve access.

scholarly journals Impact of non-communicable disease multimorbidity on health service use, catastrophic health expenditure and productivity loss in Indonesia: a population-based panel data analysis study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041870
Author(s):  
Tiara Marthias ◽  
Kanya Anindya ◽  
Nawi Ng ◽  
Barbara McPake ◽  
Rifat Atun ◽  
...  
Keyword(s):  
Panel Data ◽  
Health Service ◽  
Low Income ◽  
Health Expenditure ◽  
Service Use ◽  
Financial Burden ◽  
Panel Data Analysis ◽  
Productivity Loss ◽  
Catastrophic Health Expenditure ◽  
Health Service Use

ObjectivesTo examine non-communicable diseases (NCDs) multimorbidity level and its relation to households’ socioeconomic characteristics, health service use, catastrophic health expenditures and productivity loss.DesignThis study used panel data of the Indonesian Family Life Survey conducted in 2007 (Wave 4) and 2014 (Wave 5).SettingThe original sampling frame was based on 13 out of 27 provinces in 1993, representing 83% of the Indonesian population.ParticipantsWe included respondents aged 50 years and above in 2007, excluding those who did not participate in both Waves 4 and 5. The total number of participants in this study are 3678 respondents.Primary outcome measuresWe examined three main outcomes; health service use (outpatient and inpatient care), financial burden (catastrophic health expenditure) and productivity loss (labour participation, days primary activity missed, days confined in bed). We applied multilevel mixed-effects regression models to assess the associations between NCD multimorbidity and outcome variables,ResultsWomen were more likely to have NCD multimorbidity than men and the prevalence of NCD multimorbidity increased with higher socioeconomic status. NCD multimorbidity was associated with a higher number of outpatient visits (compared with those without NCD, incidence rate ratio (IRR) 4.25, 95% CI 3.33 to 5.42 for individuals with >3 NCDs) and inpatient visits (IRR 3.68, 95% CI 2.21 to 6.12 for individuals with >3 NCDs). NCD multimorbidity was also associated with a greater likelihood of experiencing catastrophic health expenditure (for >3 NCDs, adjusted OR (aOR) 1.69, 95% CI 1.02 to 2.81) and lower participation in the labour force (aOR 0.23, 95% CI 0.16 to 0.33) compared with no NCD.ConclusionsNCD multimorbidity is associated with substantial direct and indirect costs to individuals, households and the wider society. Our study highlights the importance of preparing health systems for addressing the burden of multimorbidity in low-income and middle-income countries.

When Vacant Lots Become Urban Gardens: Characterizing the Perceived and Actual Food Safety Concerns of Urban Agriculture in Ohio

2015 ◽  
Vol 78 (11) ◽  
pp. 2070-2080 ◽  
Author(s):  
MICHELLE L. KAISER ◽  
MICHELE L. WILLIAMS ◽  
NICHOLAS BASTA ◽  
MICHELLE HAND ◽  
SARAH HUBER
Keyword(s):  
Food Safety ◽  
Soil Quality ◽  
Urban Agriculture ◽  
Low Income ◽  
Urban Soils ◽  
Fresh Produce ◽  
Urban Gardens ◽  
Soil Contaminants ◽  
Improve Access

This study was intended to characterize the perceived risks of urban agriculture by residents of four low-income neighborhoods in which the potential exists for further urban agriculture development and to provide data to support whether any chemical hazards and foodborne pathogens as potential food safety hazards were present. Sixty-seven residents participated in focus groups related to environmental health, food security, and urban gardening. In addition, soils from six locations were tested. Residents expressed interest in the development of urban gardens to improve access to healthy, fresh produce, but they had concerns about soil quality. Soils were contaminated with lead (Pb), zinc, cadmium (Cd), and copper, but not arsenic or chromium. Results from our study suggest paint was the main source of soil contamination. Detectable polyaromatic hydrocarbon (PAH) levels in urban soils were well below levels of concern. These urban soils will require further management to reduce Pb and possibly Cd bioavailability to decrease the potential for uptake into food crops. Although the number of locations in this study is limited, results suggest lower levels of soil contaminants at well-established gardens. Soil tillage associated with long-term gardening could have diluted the soil metal contaminants by mixing the contaminants with clean soil. Also, lower PAH levels in long-term gardening could be due to enhanced microbial activity and PAH degradation, dilution, or both due to mixing, similar to metals. No foodborne pathogen targets were detected by PCR from any of the soils. Residents expressed the need for clearness regarding soil quality and gardening practices in their neighborhoods to consume food grown in these urban areas. Results from this study suggest long-term gardening has the potential to reduce soil contaminants and their potential threat to food quality and human health and to improve access to fresh produce in low-income urban communities.

scholarly journals Urban-Rural Disparities in Vaccination Service Use Among Low-Income Adolescents

2020 ◽  
Author(s):  
Yuping Tsai ◽  
Megan C. Lindley ◽  
Fangjun Zhou ◽  
Shannon Stokley
Keyword(s):  
Low Income ◽  
Service Use ◽  
Urban Rural

Impact of Medicaid expansion on two-year mortality among stage IV breast cancer (BC) patients according to race.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6525-6525
Author(s):  
Catalina Malinowski ◽  
Xiudong Lei ◽  
Hui Zhao ◽  
Sharon H. Giordano ◽  
Mariana Chavez Mac Gregor
Keyword(s):  
Breast Cancer ◽  
Low Income ◽  
Stage Iv ◽  
Medicaid Expansion ◽  
Risk Of Death ◽  
Stage Iv Breast Cancer ◽  
Increased Risk ◽  
The Impact ◽  
Expansion Period ◽  
White Patients

6525 Background: Inadequate access to healthcare services is associated with worse outcomes. Disparities in access to cancer care are more frequently seen among racial/ethnic minorities, uninsured patients, and those with low socioeconomic status. A provision in the Affordable Care Act called for expansion of Medicaid eligibility in order to cover more low-income Americans. In this study, we evaluate the impact of Medicaid expansion in 2-year mortality among metastatic BC patients according to race. Methods: Women (aged 40-64) diagnosed with metastatic BC (stage IV de novo) between 01/01/2010 and 12/31/2015 and residing in states that underwent Medicaid expansion in 01/2014 were identified in the National Cancer Database. For comparison purposes, 2010-2013 was considered the pre-expansion period and 2014-2015 the post-expansion period. We calculated 2-year mortality difference-in-difference (DID) estimates between White and non-White patients using multivariable linear regression models. Results are presented as adjusted differences (in % points) between groups in the pre- and post-expansion periods and as adjusted DID with 95%CI. Covariates included age, comorbidity, BC subtype, insurance type, transfer of care, distance to hospital, region, residence area, education, income quartile, facility type and facility volume. In addition, overall survival (OS) was evaluated in pre- and post-expansion periods via Kaplan-Meier method and Cox proportional hazards models; results are presented as 2-year OS estimates, hazard ratios (HRs), and 95% CIs. Results: Among 7,675 patients included, 4,942 were diagnosed in the pre- and 2,733 in the post-expansion period. We observed a reduction in 2-year mortality rates in both groups according to Medicaid expansion. Among Whites 2-year mortality decreased from 42.5% to 38.7% and among non-Whites from 45.4% to 36.4%, resulting in an adjusted DID of -5.2% (95%CI -9.8 to -0.6, p = 0.027). A greater reduction in 2-year mortality was observed among non-Whites in a sub-analysis of patients who resided in the poorest quartile (n = 1372), with an adjusted DID of -14.6% (95%CI -24.8 to -4.4, p = 0.005). In the multivariable Cox model, during the pre-expansion period there was an increased risk of death for non-Whites compared to Whites (HR 1.14, 95% CI 1.03 to 1.26, P = 0.04), however no differences were seen in the post-expansion period between the two groups (HR 0.93, 95% CI 0.80 to 1.07, P = 0.31). Conclusions: Medicaid expansion reduced racial disparities by decreasing the 2-year mortality of non-White patients with metastatic breast cancer and reducing the gap when compared to Whites. These results highlight the positive impact of policies aimed at improving equity and increasing access to health care.

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