scholarly journals Social-Ecological Barriers to Access to Healthcare for Adolescents: A Scoping Review

2021 ◽  
Vol 18 (8) ◽  
pp. 4138
Author(s):  
Whitney Garney ◽  
Kelly Wilson ◽  
Kobi V. Ajayi ◽  
Sonya Panjwani ◽  
Skylar M. Love ◽  
...  
Keyword(s):  
United States ◽  
Scoping Review ◽  
Healthcare Access ◽  
Insurance Coverage ◽  
Healthcare Services ◽  
The United States ◽  
Access To Healthcare ◽  
Structural Barriers ◽  
Social Ecological ◽  
Ecological Barriers

Access to healthcare for adolescents is often overlooked in the United States due to federal and state-sponsored insurance programs such as Medicaid and the Children’s Health Insurance Program. While these types of programs provide some relief, the issue of healthcare access goes beyond insurance coverage and includes an array of ecological factors that hinder youths from receiving services. The purpose of this scoping review was to identify social-ecological barriers to adolescents’ healthcare access and utilization in the United States. We followed the PRISMA and scoping review methodological framework to conduct a comprehensive literature search in eight electronic databases for peer-reviewed articles published between 2010 and 2020. An inductive content analysis was performed to thematize the categories identified in the data extraction based on the Social-Ecological Model (SEM). Fifty studies were identified. Barriers across the five SEM levels emerged as primary themes within the literature, including intrapersonal-limited knowledge of and poor previous experiences with healthcare services, interpersonal-cultural and linguistic barriers, organizational-structural barriers in healthcare systems, community-social stigma, and policy-inadequate insurance coverage. Healthcare access for adolescents is a systems-level problem requiring a multifaceted approach that considers complex and adaptive behaviors.

scholarly journals Ventanillas de Salud: Defeating challenges in healthcare access for Mexican immigrants in the United States

2020 ◽  
Vol 21 ◽  
Author(s):  
Valeria Marina Valle ◽  
Wilma Laura Gandoy Vázquez ◽  
Karla Angélica Valenzuela Moreno
Keyword(s):  
United States ◽  
Mexican Immigrants ◽  
Healthcare Access ◽  
Healthcare Services ◽  
The United States ◽  
Access To Health Services ◽  
Government Officials ◽  
Access To Health ◽  
Mexican Government

The 2010 Affordable Care Act (ACA) improved access to healthcare in the United States. However, immigrants —especially those undocumented— still faced difficulties, which have increased during the Trump administration. In order to bring access to health services to its nationals, the Mexican government has implemented the Health Windows Program (Ventanillas de Salud, or VDS). The article reviews changes in the U.S. healthcare system from the ACA to date, and assesses the role of VDS. The methodology is qualitative, consisting of a literature review, interviews with community leaders and Mexican government officials, and questionnaires sent to four VDS: Arizona, Florida, Idaho and Texas. Results show that VDS provide reliable and affordable access to basic healthcare services, and detection of chronic and non-communicable diseases, especially within undocumented immigrants. Public policy recommendations are offered based on these findings. Limitations of the study include the data collected, which is non-representative of all VDS.

Not a Problem at All or Excluded by Oneself, Doctors and the Law? Healthcare Workers’ Perspectives on Access to HIV-Related Healthcare Among Same-Sex Attracted Men in Tanzania

2021 ◽  
Author(s):  
Alexander Ishungisa Mwijage ◽  
Mucho Michael Mizinduko ◽  
Samuel Lazarus Likindikoki ◽  
Dan Dan Wolf Meyrowitsch ◽  
Elia John Mmbaga ◽  
...  
Keyword(s):  
Focus Group ◽  
Work Experience ◽  
Healthcare Workers ◽  
Healthcare Access ◽  
Healthcare Services ◽  
Access To Healthcare ◽  
Structural Barriers ◽  
Same Sex ◽  
Focus Group Discussions ◽  
Group Discussions

Abstract Background: Same-sex attracted men in Tanzania are disproportionately affected by HIV. Drawing on qualitative research, the present study explores healthcare providers’ perspectives on access to HIV-related healthcare services among same-sex attracted men. Methods: A qualitative study was carried out among healthcare workers in in the cities of Dar es Salaam and Tanga in Tanzania between August 2018 and October 2019. Fieldwork entailed qualitative interviewing, focus group discussions and participant observation. A purposive sampling strategy was used to select study participants who varied with respect to age, education level, work experience, and the type and location of the facilities they worked in. Twenty-four interviews and six focus group discussions were conducted.Results: This paper describes four different discourses that were identified among healthcare workers with respect to their perception of access to healthcare services for SSAM. One held that access to healthcare was not a major problem at all, another that some SSAM did not utilize healthcare services although they were available, a third that some healthcare workers prevented SSAM from gaining access to healthcare and a fourth that healthcare for gender and sexual minority persons was made difficult by structural barriers. Conclusion: Although these are four rather different takes on the prevailing circumstances with respect to healthcare access for SSAM, we suggest that they may all be ‘true’ in the sense that they grasp and highlight different aspects of the same realities.

Financing and Insurance

2018 ◽  
Author(s):  
Samuel H Zuvekas ◽  
Earle Buddy Lingle ◽  
Ardis Hanson ◽  
Bruce Lubotsky Levin
Keyword(s):  
Public Health ◽  
United States ◽  
Health Insurance ◽  
Insurance Coverage ◽  
Healthcare Providers ◽  
Health Insurance Coverage ◽  
Healthcare Services ◽  
Safety Net ◽  
The United States ◽  
Public And Private

The complexity of US healthcare systems is staggering. In 2015, Americans spent approximately $3.7 trillion on healthcare, averaging almost $10,000 per person. Further, Americans rely on a mixture of public and private health insurance coverage to pay for the bulk of the healthcare services they receive. To provide a better understanding of the financing of healthcare in the United States, this chapter examines major government healthcare programs and funding. It begins with a look at the US public health insurance system and the healthcare “safety net,” comprised of a patchwork of public, private, and philanthropic providers and programs. The next sections look at how US insurers and families pay doctors, hospitals, nursing homes, and other healthcare providers to deliver services in the United States and how pharmacy services are financed in public health.

A scoping review of acupuncture insurance coverage in the United States

2020 ◽  
pp. 096452842096421
Author(s):  
Roselle Bleck ◽  
Emma Marquez ◽  
Melanie A Gold ◽  
Carolyn L Westhoff
Keyword(s):  
United States ◽  
Scoping Review ◽  
Insurance Coverage ◽  
Research Priorities ◽  
The United States ◽  
Subject Area ◽  
Published Data ◽  
Opioid Use ◽  
Knowledge Gaps ◽  
The Impact

Background: Increasing access to non-pharmacologic pain management modalities, including acupuncture, has the potential to reduce opioid overuse. A lack of insurance coverage for acupuncture could present a barrier for both patients and providers. The objective of this scoping review was to assess the existing literature on acupuncture insurance coverage in the United States and to identify knowledge gaps and research priorities. Methods: We utilized the Arksey and O’Malley framework to guide our scoping review methodology. We followed a pre-determined study protocol for the level-one abstract and level-two full text screenings. We synthesized information into subject-area domains and identified knowledge gaps. Results: We found a lack of published data on acupuncture coverage in 44 states, especially in the Midwest and the South. Where data were available, a large proportion of acupuncture users did not have insurance coverage. Consumer demand, state mandates, and efforts to reduce opioid use were motivations to cover acupuncture. Licensed acupuncturists were less likely to be reimbursed and were reimbursed at lower rates compared to physicians. Reported barriers encountered when implementing coverage included a lack of providers, challenges determining when to offer non-pharmacologic treatments, and a lack of evidence for clinical efficacy and cost-effectiveness. Conclusion: We found a lack of recent publications and data comparing regional coverage in the United States. A key challenge is that commercial insurance plan data are not in the public domain. Further research should assess insurance coverage implementation for acupuncture and measure the impact of policy changes on acupuncture utilization and rates of opioid overuse.

scholarly journals Understanding the Healthcare Experiences and Needs of African Immigrants in the United States: A Scoping Review

2019 ◽  
Author(s):  
Ogbonnaya Isaac Omenka ◽  
Dennis P. Watson ◽  
Hugh C. Hendrie
Keyword(s):  
United States ◽  
Scoping Review ◽  
Healthcare Access ◽  
African Immigrants ◽  
The United States ◽  
Cost Of Care ◽  
Religion And Spirituality ◽  
Hand Search ◽  
Healthcare Experiences ◽  
The U.S

Abstract Background: Africans immigrants in the United States are the least-studied immigrant group, despite the research and policy efforts to address health disparities within immigrant communities. Although their healthcare experiences and needs are unique, they are often included in the “black” category, along with other phenotypically-similar groups. This process makes utilizing research data to make critical healthcare decisions specifically targeting African immigrants, difficult. The purpose of this Scoping Review was to examine extant information about African immigrant health in the U.S., in order to develop lines of inquiry using the identified knowledge-gaps. Methods: Literature published in the English language between 1980 and 2016 were reviewed in five stages: (1) identification of the question and (b) relevant studies, (c) screening, (d) data extraction and synthesis, and (e) results. Databases used included EBSCO, ProQuest, PubMed, and Google Scholar (hand-search). The articles were reviewed according to title and abstract, and studies deemed relevant were reviewed as full-text articles. Data was extracted from the selected articles using the inductive approach, which was based on the comprehensive reading and interpretive analysis of the organically emerging themes. Finally, the results from the selected articles were presented in a narrative format. Results: Culture, religion, and spirituality were identified as intertwined key contributors to the healthcare experiences of African immigrants. In addition, lack of culturally-competent healthcare, distrust, and complexity, of the U.S. health system, and the exorbitant cost of care, were identified as major healthcare access barriers.

scholarly journals Understanding the Healthcare Experiences and Needs of African Immigrants in the United States: A Scoping Review

2019 ◽  
Author(s):  
Ogbonnaya Isaac Omenka ◽  
Dennis P. Watson ◽  
Hugh C. Hendrie
Keyword(s):  
United States ◽  
Scoping Review ◽  
English Language ◽  
Healthcare Access ◽  
African Immigrants ◽  
The United States ◽  
Cost Of Care ◽  
Religion And Spirituality ◽  
Hand Search ◽  
Healthcare Experiences

Abstract Background: Africans immigrants in the United States are the least-studied immigrant group, despite the research and policy efforts to address health disparities within immigrant communities. Although their healthcare experiences and needs are unique, they are often lumped into the “black” category, along with other phenotypically-similar groups. These challenges stifle the means of accurately utilizing research data to make critical healthcare decisions regarding African immigrants. The purpose of this Scoping Review was to examine extant information about African immigrant health in the United States, in order to develop subsequent lines of inquiry using the identified knowledge-gaps. Methods: Literature published in the English language between 1980 and 2016 were reviewed in five stages: (1) identification of question and (b) relevant studies, (c) screening, (d) data extraction and synthesis, and (e) results. Databases used included EBSCO, ProQuest, PubMed, and Google Scholar (hand-search). The articles were reviewed according to title and abstract, and studies deemed relevant were reviewed as full-text articles. Data was extracted from the selected articles using the inductive approach, which was based on the comprehensive reading and interpretive analysis of the organically emerging themes. Finally, the results from the selected articles were presented in a narrative format. Results: Culture, religion, and spirituality were identified as intertwined key contributors to the healthcare experiences of African immigrants. Also, lack of culturally-competent healthcare, distrust, and complexity, of the US health system, exorbitant cost of care, were identified as major healthcare access barriers.

scholarly journals Assessing healthcare access using the Levesque’s conceptual framework– a scoping review

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Anthony Cu ◽  
Sofia Meister ◽  
Bertrand Lefebvre ◽  
Valéry Ridde
Keyword(s):  
Conceptual Framework ◽  
Scoping Review ◽  
Assessment Tool ◽  
Empirical Studies ◽  
Healthcare Access ◽  
A Priori ◽  
Healthcare Services ◽  
Access To Healthcare ◽  
Health Providers ◽  
Universal Healthcare

Abstract Introduction Countries are working hard to improve access to healthcare through Universal Healthcare Coverage. To genuinely address the problems of healthcare access, we need to recognize all the dimensions and complexities of healthcare access. Levesque’s Conceptual Framework of Access to Health introduced in 2013 provides an interesting and comprehensive perspective through the five dimensions of access and the five abilities of the population to access healthcare. The objectives of this paper are to identify and analyze all empirical studies that applied Levesque’s conceptual framework for access to healthcare and to explore the experiences and challenges of researchers who used this framework in developing tools for assessing access. Methods A scoping review was conducted by searching through four databases, for studies citing Levesque et al. 2013 to select all empirical studies focusing on healthcare access that applied the framework. An initial 1838 documents underwent title screening, followed by abstract screening, and finally full text screening by two independent reviewers. Authors of studies identified from the scoping review were also interviewed. Results There were 31 studies identified on healthcare access using the Levesque framework either a priori, to develop assessment tool/s (11 studies), or a posteriori, to organize and analyze collected data (20 studies). From the tools used, 147 unique questions on healthcare access were collected, 91 of these explored dimensions of access while 56 were about abilities to access. Those that were designed from the patient’s perspective were 73%, while 20% were for health providers, and 7% were addressed to both. Interviews from seven out of the 26 authors, showed that while there were some challenges such as instances of categorization difficulty and unequal representation of dimensions and abilities, the overall experience was positive. Conclusion Levesque’s framework has been successfully used in research that explored, assessed, and measured access in various healthcare services and settings. The framework allowed researchers to comprehensively assess the complex and dynamic process of access both in the health systems and the population contexts. There is still potential room for improvement of the framework, particularly the incorporation of time-related elements of access.

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