A Human Right to Healthcare Access: Returning to the Origins of the Patients' Rights Movement

2001 ◽  
Vol 10 (3) ◽  
pp. 285-298 ◽  
Author(s):  
JOSEPH C. d'ORONZIO
Keyword(s):  
Managed Care ◽  
Healthcare Access ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Human Right ◽  
Patients Rights ◽  
Moral Force ◽  
Long Run ◽  
Current Concern ◽  
High Level

The current concern with reforming and regulating managed care under the general rubric of “patients' rights” has eclipsed the more fundamental need to legislate the human rights of those without adequate access to any healthcare. To characterize the regulatory activity as a “rights” movement inflates its moral dimension. The concept of “rights” carries a serious and powerful moral force that is currently inappropriately applied to the parochial concerns of a segment of the population privileged to have health insurance coverage. By contrast, the language of “rights” refers to a high level of universality for the most rudimentary of human concerns. If there was a universal right to become a patient equal to other patients, a concept of patients' rights would have legitimacy. As it is, however, the central determinant of this “right” is how much the insurance policy costs and what is covered. To so diminish the meaning of “right” within the miasma of managed care is to lose sight of the real possibilities of applying a positive “right” to healthcare and, in the long run, is to diminish the ethics of healthcare.

The impact of Asian race on colorectal cancer screening (CRCS).

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 381-381
Author(s):  
B. Homayoon ◽  
N. C. Shahidi ◽  
W. Y. Cheung
Keyword(s):  
Rural Areas ◽  
English Proficiency ◽  
Healthcare Access ◽  
Insurance Coverage ◽  
Female Gender ◽  
California Health Interview Survey ◽  
Average Risk ◽  
Place Of Birth ◽  
Clinical Predictors ◽  
The Impact

381 Background: While research shows that African Americans and Hispanics frequently receive less CRCS than Whites, few studies have focused on CRCS among Asians. The aims of the current analysis were to 1) compare CRCS between Asians and Whites in a large U.S. population, 2) evaluate for other clinical predictors of CRCS, and 3) examine the impact of health insurance coverage, place of birth and English proficiency on potential racial disparities. Methods: From the 2007 California Health Interview Survey, we identified all Asian (N=2,108) and White (N=23,237) average-risk respondents aged ≥50 years who were eligible for CRCS. Logistic regression was performed to evaluate for differences in CRCS between Asians and Whites. We used stratified and interaction analyses to examine whether associations between race and CRCS were modified by insurance status (insured vs uninsured), birthplace (U.S. vs non-U.S.) or language skills (good vs poor English), while controlling for other confounders. Results: Baseline characteristics were similar between Asians and Whites: mean age was 64 years in both groups; 45% and 47% were male; and 47% and 50% were employed, respectively. Only 58% of Asians and 66% of Whites reported undergoing up-to-date CRCS (p<0.001). In multivariate analyses, female gender and those living in rural areas were less likely to receive CRCS (OR 0.84, 95%CI 0.76-0.93, p=0.001 and OR 0.88, 95%CI 0.81-0.98, p=0.015, respectively).When compared to Whites, Asians also had decreased odds of CRCS (OR 0.82, 95%CI 0.71-0.95, p=0.008), even after adjusting for confounders such as education and income. Stratified analyses revealed that this disparity existed mainly in the insured (OR 0.83, 95%CI 0.72-0.96, p=0.014), but not in the uninsured (OR 0.94, 95%CI 0.43-2.06, p=0.873). The relationship between race and CRCS was not modified by place of birth or English proficiency. Conclusions: Despite its ability to reduce mortality, CRCS is suboptimal in our U.S. population-based cohort of Asians when compared to Whites. The racial disparity was more evident within the insured subset, suggesting that factors unrelated to healthcare access, such as patient preference, physician discretion or patient-physician rapport, may be more important drivers of CRCS among Asians. No significant financial relationships to disclose.

Patterns of Healthcare Access and Utilization among Nonurban Transgender and Nonbinary Patients at a Large Safety Net Health System in Colorado

2020 ◽  
Vol 1 (3) ◽  
pp. 186-199
Author(s):  
Corey F. Walsh ◽  
Ryan P. O'Connell ◽  
Elizabeth Kvach
Keyword(s):  
Gender Identity ◽  
Health System ◽  
Healthcare Access ◽  
Insurance Coverage ◽  
Marijuana Use ◽  
Safety Net ◽  
Urban Centers ◽  
Utilization Patterns ◽  
And Gender ◽  
Distance To Care

Current research characterizing transgender and nonbinary (TNB) communities focuses on coastal, urban centers and inadequately recognizes intersections of geography and gender identity. This study evaluates demographics, health insurance, mental health, one-way distance to care, and types of care accessed for a cohort of nonurban TNB patients seeking care at a large, safety net health system in Denver, Colorado. Electronic medical record (EMR) data were used to identify this TNB patient cohort (n = 1,230) Characteristics of age, race/ethnicity, sex assigned at birth, gender identity, insurance, residence ZIP code, alcohol use disorder, tobacco use, marijuana use, depression, and anxiety were extracted. Chart review characterized utilization patterns among non-Denver TNB patients (n = 232). Denver TNB patients were more likely to have the following characteristics: black or Hispanic identity, marijuana use, commercial insurance, depression, anxiety; comparatively, non-Denver TNB patients were more likely to be white and have public insurance coverage. The non-Denver cohort traveled an average of 82.52 miles one-way. A majority of non-Denver patients accessed gender-affirming (99%), hormone-related (81%), primary (78%), and preventive (69%) care. A minority of these patients (23%) accessed surgical transition care. Proximity to care is one of many important factors for TNB patients seeking care. The number of non-Denver TNB traveling for healthcare likely reflects a lack of accessibility to local gender-affirming care, which should prompt nonurban medical providers to seek training that meets this need. Medical educators should improve teaching on gender-affirming healthcare, particularly for rural educational tracks.

scholarly journals Clinical Uncertainty and Healthcare Disparities

2003 ◽  
Vol 29 (2-3) ◽  
pp. 203-219 ◽  
Author(s):  
Ana I. Balsa ◽  
Naomi Seiler ◽  
Thomas G. McGuire ◽  
M. Gregg Bloche
Keyword(s):  
Healthcare System ◽  
Minority Groups ◽  
Healthcare Access ◽  
Insurance Coverage ◽  
Ethnic Disparities ◽  
Clinical Encounter ◽  
Racial And Ethnic Disparities ◽  
Institute Of Medicine ◽  
Unequal Treatment

The Institute of Medicine Report, Unequal Treatment: Confronting Racial and Ethnic Disparities, affirms in its first finding: “Racial and ethnic disparities in healthcare exist and, because they are associated with worse outcomes in many cases, are unacceptable.” The mechanisms that generate racial and ethnic disparities in medical care operate at the levels of the healthcare system and the clinical encounter. Research demonstrates the role of healthcare system factors, including differences in insurance coverage and other determinants of healthcare access, in producing disparities. Research also shows, however, that even when insurance status and other measures of access are controlled for by statistical methods, racial and ethnic disparities persist. These disparities remain when researchers try by various methods to control for patients’ clinical characteristics. Disparities are especially well documented through comparisons between white patients and African Americans and Latinos, but they are believed to affect other minority groups. As a result, many members of minority racial and ethnic groups receive less or inferior care.

scholarly journals Healthcare experiences of urban young adult lesbians

2020 ◽  
Vol 16 ◽  
pp. 174550651989982
Author(s):  
Marybec Griffin ◽  
Jessica Jaiswal ◽  
Dawn Krytusa ◽  
Kristen D Krause ◽  
Farzana Kapadia ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
New York City ◽  
Young Adult ◽  
Healthcare Access ◽  
Insurance Coverage ◽  
Pap Testing ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Healthcare Experiences

Purpose: This cross-sectional study of young adult lesbians explores their healthcare experiences including having a primary care provider, forgone care, knowledge of where to obtain Pap testing, and sexually transmitted infection testing. Methods: Quantitative surveys were conducted at lesbian, gay, bisexual, and transgender venues and events with a sample of 100 young adult lesbians in New York City between June and October 2016. Using the Andersen model of healthcare access, this study examined associations between sociodemographic characteristics and healthcare experiences using multivariable logistic regression models. Results: Having a primary care provider was associated with having health insurance (adjusted odds ratio (AOR) = 4.9, p < 0.05). Both insurance (AOR = 0.2, p < 0.05) and employment (AOR = 0.2, p < 0.05) status were protective against foregone care among young adult lesbians. Disclosure of sexual orientation to a provider improved knowledge of where to access Pap testing (AOR = 7.5, p < 0.05). Disclosure of sexual orientation to friends and family improved knowledge of where to access sexually transmitted infection testing (AOR = 3.6, p < 0.05). Conclusion: Socioeconomic factors are significantly associated with healthcare access among young adult lesbians in New York City. Maintaining non-discrimination protections for both healthcare services and insurance coverage are important for this population. In addition, financial subsidies that lower the cost of health insurance coverage may also help improve healthcare access among young adult lesbians.

Healthcare access disparity among U.S. cancer population and evaluation of social determinants of health using NHANES data for 2013-18.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18527-e18527
Author(s):  
Ahsan Wahab ◽  
Abdul Rafae ◽  
Kamran Mushtaq ◽  
Adeel Masood ◽  
Hamid Ehsan ◽  
...  
Keyword(s):  
Ethnic Minorities ◽  
Sex Education ◽  
Healthcare Access ◽  
Insurance Coverage ◽  
Cross Sectional Study ◽  
Socioeconomic Indicators ◽  
Chi Square ◽  
Cross Sectional ◽  
History Of ◽  
Poor Outcomes

e18527 Background: Ethnic minorities in US have poorer outcomes due to poor socioeconomic determinants. We evaluated association between ethnicity and insurance status among US adults with cancer who participated in National Health and Nutrition Examination survey for 2013-18. Methods: This was a cross-sectional study involving participants with history of cancer; participants with missing insurance/ethnicity information were excluded. Outcome of interest was insurance coverage in minorities vs Whites. The comparison of baseline characteristics (Table) stratified by insurance (Yes vs No) was made using Chi-square and t-tests incorporating survey procedures in SAS v. 9.4. Logistic regression was used for adjusted and unadjusted odds ratio (OR). Results: Among 29,400 participants, 1,684 had cancer. After excluding 81 participants with missing data, 1,603 were included; 5.2% were uninsured. Table summarizes characteristics of participants stratified by insurance. The uninsured individuals were 14 years younger, predominantly females, Hispanics and non-US born, and were less educated compared to the insured. Unadjusted OR of no insurance vs insurance was 4.23 (95%CI: 2.40-7.47) for Hispanics, 1.23 (95%CI: 0.64- 2.38) for Blacks and 1.50 for others (95%CI: 0.48-4.74) when compared to Whites. After adjusting for age, sex, education, US born status and routine place for medical care, OR for Hispanics, Blacks and others were 1.31 (95%CI: 0.73-2.36), 1.00 (95%CI: 0.46-2.18) and 0.86 (95%CI: 0.26-2.78), respectively. Conclusions: Poor socioeconomic indicators among US cancer population may leave them being uninsured; thereby making them vulnerable to poor outcomes in particular in the ethnic minorities including Hispanics. [Table: see text]

scholarly journals The door is open, but not everyone may enter: racial inequities in healthcare access across three Brazilian surveys

2021 ◽  
Vol 26 (9) ◽  
pp. 3981-3990
Author(s):  
Helena Mendes Constante ◽  
Gerson Luiz Marinho ◽  
João Luiz Bastos
Keyword(s):  
Primary Care ◽  
Survey Design ◽  
Healthcare Access ◽  
Insurance Coverage ◽  
Family Health ◽  
Health Insurance Coverage ◽  
Care Policy ◽  
Sampling Weights ◽  
Unified Health System ◽  
The Impact

Abstract Health policies in Brazil have sought to expand healthcare access and mitigate inequities, but recent revisions of their content have weakened the Brazilian Unified Health System. This study estimates three healthcare indicators across three national surveys conducted in 2008, 2013, and 2019 to assess the impact of changes to the National Primary Care Policy on racial inequities in healthcare. Considering the survey design and sampling weights, we estimated the prevalence of each outcome among both whites and Blacks for the whole country, and according to the Brazilian regions. We test the following hypotheses: compared to whites, Blacks showed higher frequency of coverage by the Family Health Strategy, lower frequency of health insurance coverage, and higher frequency of perceived difficulty accessing health services (H1); Racial inequities decreased in the ten-year period but remained constant between 2013-2019 (H2); Racial gaps have widened among regions with lower proportions of Blacks (H3). Our findings fully support H1, but not H2 and H3. Racial inequities either remained constant or decreased in the 2013-2019 period. By downplaying the importance of the universality and equity principles, the latest revision of the National Primary Care Policy has contributed to the persistence of racial inequities in healthcare.

scholarly journals Healthcare Access and Utilization Among Persons Who Inject Drugs in Medicaid Expansion and Nonexpansion States: 22 United States Cities, 2018

2020 ◽  
Vol 222 (Supplement_5) ◽  
pp. S420-S428
Author(s):  
Rashunda Lewis ◽  
Amy R Baugher ◽  
Teresa Finlayson ◽  
Cyprian Wejnert ◽  
Catlainn Sionean ◽  
...  
Keyword(s):  
Healthcare Access ◽  
Insurance Coverage ◽  
Unmet Need ◽  
Opioid Overdose ◽  
Medicaid Expansion ◽  
Persons Who Inject Drugs ◽  
Medication Assisted Treatment ◽  
National Hiv Behavioral Surveillance ◽  
Immunodeficiency Virus ◽  
Healthcare Access And Utilization

Abstract Background Medicaid expansion under the Affordable Care Act increased insurance coverage, access to healthcare, and substance use disorder treatment, for many Americans. We assessed differences in healthcare access and utilization among persons who inject drugs (PWID) by state Medicaid expansion status. Methods In 2018, PWID were interviewed in 22 US cities for National HIV Behavioral Surveillance. We analyzed data from PWID aged 18–64 years who reported illicit use of opioids (n = 9957) in the past 12 months. Poisson regression models with robust standard errors were used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were used to examine differences by Medicaid expansion status in indicators of healthcare access and utilization. Results Persons who inject drugs in Medicaid expansion states were more likely to have insurance (87% vs 36%; aPR, 2.3; 95% CI, 2.0–2.6), a usual source of healthcare (53% vs 34%; aPR, 1.5; 95% CI, 1.3–1.9), and have used medication-assisted treatment (61% vs 36%; aPR, 1.4; 95% CI, 1.1–1.7), and they were less likely to have an unmet need for care (21% vs 39%; aPR, 0.6; 95% CI, 0.4–0.7) than those in nonexpansion states. Conclusions Low insurance coverage, healthcare access, and medication-assisted treatment utilization among PWID in some areas could hinder efforts to end the intertwined human immunodeficiency virus and opioid overdose epidemics.

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