Decolonizing the U.S. Health Care System: Undocumented and Disabled after ACA

The Affordable Care Act (ACA) explicitly denies newly arrived documented and undocumented immigrants health insurance coverage, effectively making them the largest remaining uninsured segment of the U.S. population. Using mixed qualitative methods, our original research illustrates the health consequences experienced by uninsured, disabled undocumented immigrants as they navigate what they describe as an apartheid health care system. Critiquing the notion of immigrants as “public charges” or burdens on the system, our qualitative analysis focuses on Houston Health Action, a community-based organization led by and for undocumented, low-income disabled immigrants in Houston, Texas. Engaging a critical migration and critical disabilities studies framework, we use this valuable case to highlight contemporary contradictions in health care and immigration legislation and the embodied consequences of the intersecting oppressions of race, ability, immigration status, and health care access.

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Pharmacist Contributions to the U.S. Health Care System Reported in the 2009 and 2014 National Pharmacist Workforce Surveys

INNOVATIONS in pharmacy ◽

10.24926/iip.v6i2.382 ◽

2015 ◽

Vol 6 (2) ◽

Cited By ~ 7

Author(s):

Jon C. Schommer ◽

Caroline A. Gaither ◽

William R. Doucette ◽

David H. Kreling ◽

David A. Mott

Keyword(s):

Health Care ◽

Health Care System ◽

Original Research ◽

Pharmacist Workforce ◽

The U.S ◽

Care System

Type: Original Research

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Unsanitized and Unfair: How COVID-19 Bailout Funds Refuel Inequity in the U.S. Health Care System

Journal of Health Politics Policy and Law ◽

10.1215/03616878-9155977 ◽

2021 ◽

Author(s):

Colleen M. Grogan ◽

Michael K. Gusmano ◽

Yu-An Lin

Keyword(s):

Health Care ◽

Health Care System ◽

Low Income ◽

Safety Net ◽

Hospital Data ◽

Health Care Safety Net ◽

Relief Fund ◽

Financial Need ◽

The U.S ◽

Care System

Abstract Context: The CARES Act of 2020 allocated provider relief funds to hospitals and other providers. We investigate whether these funds were distributed in a way that responded fairly to COVID-19-related medical and financial need. The U.S. health care system is bifurcated into the “haves” and “have nots.” The health care safety net hospitals, which were already financially weak, cared for the bulk of COVID-19 cases. In contrast, the “have” hospitals suffered financially because their most profitable procedures are elective and were postponed during the COVID-19 outbreak. Methods: To obtain relief fund data for each hospital in the U.S., we start with data from HHS posted on the CDC website. We use RAND Hospital Data to analyze how fund distributions are associated with hospital characteristics. Findings: Our analysis reveals that the “have” hospitals with the most days of cash on hand received more funding per bed than hospitals with fewer than 50 days of cash on hand (the “have nots”). Conclusions: Despite extreme racial inequities, which COVID-19 exposed early on in the pandemic, the federal government rewards those hospitals that cater to the most privileged in the U.S., leaving hospitals that predominantly serve low-income people of color with less.

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Determinants of employment-based private health insurance coverage in Denmark

Nordic Journal of Health Economics ◽

10.5617/njhe.194 ◽

2011 ◽

Vol 1 (1) ◽

Cited By ~ 4

Author(s):

Astrid Kiil

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Care System ◽

Private Health Insurance ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

Actual Choice ◽

Fair Poor ◽

Self Assessed Health ◽

Care System

This study estimates the determinants of having employment-based private health insurance (EPHI) based on data from a survey of the Danish workforce conducted in 2009. The study contributes to the literature by exploring the role of satisfaction with the tax-financed health care system as a potential determinant of EPHI ownership and by taking into account that some employees receive EPHI free of charge, while others pay the premium out of their pre-tax income and thus make an actual choice. The results indicate that the probability of having EPHI is positively affected by private sector employment, size of the workplace, whether the workplace has a health scheme, income, being employed as a white-collar worker, and age until the age of 49, while the presence of subordinates, gender, education level, membership of 'denmark' and living in the capital region are not significantly associated with EPHI coverage. As expected, the characteristics related to the workplace are by far the quantitatively most important determinants. The association between EPHI and self-assessed health is found to be quadratic such that individuals in good self-assessed health are more likely to be covered by EPHI than those in excellent and fair, poor or very poor self-assessed health, respectively. Finally, the probability of having EPHI is found to be negatively related to the level of satisfaction with the tax-financed health care system. The findings of the study are not affected notably by distinguishing empirically between employees who receive EPHI free of charge and those who pay the premium out of their pre-tax income. Link to Appendix

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The Personal Financial Burden of Chronic Rhinosinusitis: A Canadian Perspective

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2017.31.4452 ◽

2017 ◽

Vol 31 (4) ◽

pp. 216-221 ◽

Cited By ~ 9

Author(s):

Jonathan Yip ◽

Allan D. Vescan ◽

Ian J. Witterick ◽

Eric Monteiro

Keyword(s):

Health Care ◽

Health Insurance ◽

Chronic Rhinosinusitis ◽

Health Care System ◽

Financial Burden ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

Perceived Burden ◽

Snot 22 ◽

Care System

Background Previous studies describe the financial burden of chronic rhinosinusitis (CRS) from the perspective of third-party payers, but, to our knowledge, none analyze the costs borne by patients (i.e., out-of-pocket expenses [OOPE]). Furthermore, this burden has not been previously investigated in the context of a publicly funded health care system. Objective The purpose of this study was to characterize the financial impact of CRS on patients, specifically by evaluating its associated OOPEs and the perceived financial burden. The secondary aim was to determine the factors predictive of OOPEs and perceived burden. Methods Patients with CRS at a tertiary care sinus center completed a self-administered questionnaire that assessed their socioeconomic characteristics, disease-specific quality of life (22-item Sino-Nasal Outcome Test [SNOT-22]), workdays missed due to CRS, perceived financial burden, and direct medical and nonmedical OOPEs over a 12-month period. Total OOPEs were calculated from the sum of direct medical and nonmedical OOPEs. Regression analyses determined factors predictive of OOPEs and the perceived burden. Results A total of 84 patients completed the questionnaires. After accounting for health insurance coverage and the median direct medical, direct nonmedical, and total OOPEs per patient over a 12-month period were Canadian dollars (CAD) $336.00 (2011) [U.S. $339.85], CAD $129.87 [U.S. $131.86], and CAD $607.10 [U.S. $614.06], respectively. CRS resulted in an average of 20.6 workdays missed over a 12-month period. Factors predictive of a higher financial burden included younger age, a greater number of previous sinus surgeries, <80% health insurance coverage, residing out of town, and higher SNOT-22 scores. Conclusion Total OOPEs incurred from the treatment of CRS may amount to CAD $607.10 [U.S. $614.06] per patient per year, within the context of a single-payer health care system. Managing clinicians should be aware of patient groups with a greater perceived financial burden and consider counseling them on strategies to offset expenses, including obtaining travel grants, using telemedicine for follow-up assessments, providing drug samples, and streamlining diagnostic testing with medical visits.

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