Does Managed Care Improve Access to Care for Medicaid Beneficiaries with Disabilities? A National Study

2008 ◽  
Vol 45 (4) ◽  
pp. 395-407 ◽  
Author(s):  
Teresa A. Coughlin ◽  
Sharon K. Long ◽  
John A. Graves
Keyword(s):  
Managed Care ◽  
Access To Care ◽  
Rural Areas ◽  
Urban Areas ◽  
Control Program ◽  
National Study ◽  
Fee For Service ◽  
Pooled Data ◽  
Medicaid Beneficiaries ◽  
Program Costs

States increasingly are shifting Medicaid beneficiaries with disabilities from the fee-for-service (FFS) delivery system to managed care in an effort to control program costs and address long-standing problems with access to care under the program. Using a county-based measure of managed care enrollment and pooled data from the 1997 to 2004 National Health Interview Surveys, we investigate whether Medicaid managed care (MMC), relative to FFS Medicaid, improves access to care. We find some evidence of improved access to care under MMC; however, the gains appear to be largely limited to beneficiaries in urban areas with fully capitated managed care. There is little evidence of improved access under primary care case management or, regardless of MMC type, in rural areas.

Plan Choice and Changes in Access to Care over Time for SSI-Eligible Children with Disabilities

2005 ◽  
Vol 42 (2) ◽  
pp. 145-159 ◽  
Author(s):  
Pamela N. Roberto ◽  
Jean M. Mitchell ◽  
Darrell J. Gaskin
Keyword(s):  
Managed Care ◽  
Access To Care ◽  
Estimation Procedure ◽  
Care Plan ◽  
Care Hospital ◽  
Fee For Service ◽  
Special Needs Children ◽  
Plan Choice ◽  
Two Step Estimation ◽  
Over Time

This paper analyzes how voluntary enrollment in the fee-for-service (FFS) system versus a partially capitated managed care plan affects changes in access to care over time for special needs children who receive Supplemental Security Income (SSI) due to a disability. Four indicators of access are evaluated, including specialty care, hospital care, emergency care, and access to a regular doctor. We employ the Heckman two-step estimation procedure to correct for the potential nonrandom selection bias linked to plan choice. The findings show that relative to their counterparts in the partially capitated managed care plan, SSI children enrolled in the FFS plan are significantly more likely to encounter an access problem during either of the time periods studied. Similarly, FFS enrollees are significantly more likely than partially capitated managed care participants to experience persistent access problems across three of the four dimensions of care. Possible explanations for the deterioration in access associated with FFS include the lack of case management services, lower reimbursement relative to the partially capitated managed care plan, and provider availability.

scholarly journals Prevalence and access to care for cardiovascular risk factors in older people in Sierra Leone: a cross-sectional survey

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038520
Author(s):  
Maria Lisa Odland ◽  
Tahir Bockarie ◽  
Haja Wurie ◽  
Rashid Ansumana ◽  
Joseph Lamin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Access To Care ◽  
Sierra Leone ◽  
Low Income ◽  
Rural Areas ◽  
Urban Areas ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Health System Strengthening ◽  
Low Income Countries

IntroductionPrevalence of cardiovascular disease risk factors (CVDRFs) is increasing, especially in low-income countries. In Sierra Leone, there is limited empirical data on the prevalence of CVDRFs, and there are no previous studies on the access to care for these conditions.MethodsThis study in rural and urban Sierra Leone collected demographic, anthropometric measurements and clinical data from randomly sampled individuals over 40 years old using a household survey. We describe the prevalence of the following risk factors: diabetes, hypertension, dyslipidaemia, overweight or obesity, smoking and having at least one of these risk factors. Cascades of care were constructed for diabetes and hypertension using % of the population with the disease who had previously been tested (‘screened’), knew of their condition (‘diagnosed’), were on treatment (‘treated’) or were controlled to target (‘controlled’). Multivariable regression was used to test associations between prevalence of CVDRFs and progress through the cascade for hypertension with demographic and socioeconomic variables. In those with recognised disease who did not seek care, reasons for not accessing care were recorded.ResultsOf 2071 people, 49.6% (95% CI 49.3% to 50.0%) of the population had hypertension, 3.5% (3.4% to 3.6%) had diabetes, 6.7% (6.5% to 7.0%) had dyslipidaemia, 25.6% (25.4% to 25.9%) smoked and 26.5% (26.3% to 26.8%) were overweight/obese; a total of 77.1% (76.6% to 77.5%) had at least one CVDRF. People in urban areas were more likely to have diabetes and be overweight than those living in rural areas. Moreover, being female, more educated or wealthier increased the risk of having all CVDRFs except for smoking. There is a substantial loss of patients at each step of the care cascade for both diabetes and hypertension, with less than 10% of the total population with the conditions being screened, diagnosed, treated and controlled. The most common reasons for not seeking care were lack of knowledge and cost.ConclusionsIn Sierra Leone, CVDRFs are prevalent and access to care is low. Health system strengthening with a focus on increased access to quality care for CVDRFs is urgently needed.

scholarly journals Biting rhythm, fecundity and longevity rate of Aedes albopictus (Skuse) females from different urbanized settings in Penang Island, Malaysia under uncontrolled laboratory conditions

2019 ◽  
Author(s):  
Nor Atikah Farhah Muhammad ◽  
Nur Faeza Abu Kassim ◽  
Abdul Hafiz Ab Majid ◽  
Hamady Dieng ◽  
Silas Wintuma Avicor
Keyword(s):  
Aedes Albopictus ◽  
Standard Error ◽  
Rural Areas ◽  
Disease Transmission ◽  
Urban Areas ◽  
Environmental Changes ◽  
Control Program ◽  
Laboratory Strain ◽  
Adult Survival ◽  
Fecundity Rate

AbstractUrbanization could potentially modify Aedes albopictus’ ecology by changing the dynamics of the species, and increasing the abundance of their breeding sites due to environmental changes, and thus contribute to dengue outbreaks. An efficient control of the vector requires a deeper understanding on the biological components of this vector. Thus, this study was conducted to evaluate the biting rhythm, fecundity and longevity rate of Ae. albopictus in relation to urbanization strata; urban, suburban and rural areas in Penang Island, Malaysia. The experiments were done in comparison to a laboratory strain. Twenty-four hours biting activity of all the mosquito strains showed a clear bimodal biting activity, with morning and evening twilight peaks. A two-way analysis of variance (ANOVA) found that there was statistically no significant interaction (F(69,192) = 1.337, P > 0.05) between the effects of biting time and mosquito strains. Meanwhile, fecundity rates were shown to be statistically significantly different between mosquito strains (F(3,442) = 10.559, P < 0.05) with urban areas having higher mean number of eggs (mean = 107.69, standard error = 3.98) than suburban (mean = 94.48, standard error = 5.18), and rural areas (mean = 72.52, standard error = 3.87). Longevity rates were significantly higher (F(3,441) = 31.259, P < 0.05) for mosquito strains from urban areas compared to the other strains. These findings would provide crucial and relevant fundamental information to the planning of control program in Malaysia, particularly Penang.Author SummaryAedes mosquito populations associated with human habitation in urban area do not only have the potential to cause biting nuisance, but also cause significant public health risks through the transmission of dengue virus. The socioeconomic effects of urbanization have been comprehensively studied by socio-ecologists, but the ecological effects and their impact on this vector biology was not known. The authors found that in Penang Island, the mean number of eggs laid per female of Aedes albopictus is high in the urban areas than those in suburban and rural areas. The survivorship is high for urban populations parallel to the fecundity rate and apparent biting pattern which is peak at dawn and dusk was noted for all Ae. albopictus strains. The changed environment in the urbanized area where more kinds of breeding containers and more blood sources produced by condensed human population supported by warm climate may facilitate larval development, enhance the vector survivorship and its reproductive fitness. These might be the reasons for quick adaptation and susceptibility of Ae. albopictus in urban areas. As higher fecundity rate and longer adult survival may enhance disease transmission, this species studied is indeed need high attention in terms of vector control.

scholarly journals Prevalence of tobacco use in urban and rural areas of Pakistan; a sub-study from second National Diabetes Survey of Pakistan (NDSP) 2016 - 2017

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
Abdul Basit ◽  
Bilal Bin Younus ◽  
Nazish Waris ◽  
Asher Fawwad ◽  
NDSP Members*
Keyword(s):  
Tobacco Use ◽  
Rural Areas ◽  
Urban Areas ◽  
Multinomial Logistic Regression ◽  
Control Program ◽  
Ratio Test ◽  
Multinomial Logistic Regression Analysis ◽  
Creative Commons ◽  
Diabetes Survey ◽  
Urban And Rural Areas

Objective: To assess age standardized prevalence of tobacco use in urban and rural areas of Pakistan. Methods: This is a sub-study of second National Diabetes Survey of Pakistan (NDSP) 2016-2017. Prevalence of tobacco, ex-tobacco and non-tobacco users was determined in urban/rural areas of four provinces (Punjab, Sindh, Khyber Pakhtunkhwa, and Baluchistan) of Pakistan amongst people aged greater than or equal to 20 years. Information regarding tobacco and non-tobacco users were obtained from second NDSP (2016-2017) predesigned questionnaire. Detailed methodology for demographic, anthropometric and biochemical parameters remained same as reported in second NDSP (2016-2017). Results: The age-standardized prevalence of tobacco use in Pakistan was found to be 13.4%. Tobacco use in urban areas was 16.3% and rural areas was 11.7%. Tobacco use in urban and rural males was 26.1% and 24.1%, while in females was 7.7% and 3.1%, respectively. The age-standardized prevalence of ex-tobacco use in Pakistan was found to be 2.3%. Ex-tobacco use in urban areas was 2.6% and rural areas was 2.3%. Similarly, ex-tobacco use in urban and rural males was 4.6% and 4.6%, while in females was 0.7% and 0.5%, respectively. Multinomial logistic regression analysis shows that increasing age does not relate towards addiction of tobacco. Males were found to be 7 times (OR 6.94, 95% CI 5.68-8.49) and urban residents twice (OR 2.09, 95% CI 1.73-2.52) more tobacco users than females and those living in rural areas, respectively. From the likelihood ratio test, all variables were found to be statistically significant except for dysglycemia, dyslipidemia and hypertension. Conclusion: The prevalence of tobacco use is high. As a sub paper of a large national survey, this evidence is expected to serve as an important tool to plan larger studies leading in turn to develop strategies for a successful tobacco control program in the country. doi: https://doi.org/10.12669/pjms.36.4.1705 How to cite this:Basit A, Younus BB, Waris N, Fawwad A, NDSP members. Prevalence of tobacco use in urban and rural areas of Pakistan; a sub-study from second National Diabetes Survey of Pakistan (NDSP) 2016 - 2017. Pak J Med Sci. 2020;36(4):---------.  doi: https://doi.org/10.12669/pjms.36.4.1705 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Epidemiology of animal bite in Iran during a 20-year period (1993–2013): a meta-analysis

2019 ◽  
Vol 47 (1) ◽  
Author(s):  
Maliheh Abedi ◽  
Amin Doosti-Irani ◽  
Fatemeh Jahanbakhsh ◽  
Amirhossein Sahebkar
Keyword(s):  
Incidence Rate ◽  
Rural Areas ◽  
Urban Areas ◽  
Meta Analysis ◽  
Control Program ◽  
Accurate Data ◽  
Cross Sectional ◽  
Significant Difference ◽  
Efficient Resource ◽  
Incident Rate

Abstract Background Rabies is a fatal disease that still kills 2–6 people a year in Iran. A meta-analysis was conducted in order to generate accurate data on animal bite exposure, and to estimate the incidence of animal bite across the country. Materials and methods Major national and international electronic databases were searched using the keywords “animal bite,” rabies, prevalence, incidence, and Iran. Web of Knowledge, PubMed, Scopus, Ovid, and ScienceDirect were used as international databases, and the national databases included Science Information Database, MagIran, and IranDoc. Descriptive cross-sectional studies addressing the incidence of animal bite were selected and screened by two authors, and pre-specified data were extracted. The population of provinces or cities of studies was extracted from the Statistical Centre of Iran. The overall incidence of animal bite in Iran was estimated using a random-effects model with 95% confidence interval (CI). Study quality was assessed using the STROBE recommended checklist. Results A total of 34 studies were selected for the meta-analysis out of 1215 retrieved studies. The number of animal bites in the studies during 1993–2013 was 230,019 cases. The overall estimated incidence rate of animal bite in Iran was 13.20/1000 (95%, CI 12.10, 14.30) and the mean age of people was 26.23 (SD = 5.02) year. The incidence rate of animal bite among males (14.90/1000) was much higher than females (4.55/1000), and was higher in rural areas (17.45/1000) compared with urban areas (4.35/1000). The incident rate was highest among students compared with other reported occupations. The incidence rate of dogs was 10.40/1000 followed by cats, cows, wolves, jackals, and foxes. Domestic animals had a higher incidence rate than stray and wild animals. The incidence rate of animal bite during spring was 4.90/1000; however, the incidence rate in other seasons had no significant difference. In the retrieved studies, the highest incidence rate of animal bite was found in the West Azerbaijan Province (146.83/1000). Conclusion The current study is the first comprehensive analysis of the published animal bite studies in Iran. Accurate data on animal bite incidence may lead to more effective policy-decisions towards more efficient resource allocation to primary health care for reducing rabies case. Such information is a primary and major necessity for rabies control program in the country. Animal bite reduction can significantly minimize the risk of rabies infection, thereby reducing public health costs for the expensive post-exposure treatment.

scholarly journals Could Improving Choice and Competition in Medicare Advantage be the Future of Medicare?

2015 ◽  
Vol 18 (2) ◽  
pp. 151-168 ◽  
Author(s):  
Alice M. Rivlin ◽  
Willem Daniel
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Competitive Bidding ◽  
Fee For Service ◽  
Medicare Advantage ◽  
Medicare Beneficiaries ◽  
Meaningful Improvement ◽  
Service Plan ◽  
The Cost ◽  
Do So

Abstract About 30 percent of Medicare beneficiaries enroll in private Medicare Advantage (MA) plans but do so at a relatively high-cost. This paper explores the advantages and challenges of introducing competitive bidding among MA plans (Plan One) or among MA plans and Fee-for-Service (Plan Two or Premium Support). We conclude that competitive bidding could reduce the cost of Medicare, especially in densely populated urban areas. However, there would be serious challenges in rural areas and risk adjustment methodology would have to be substantially improved. In Plan Two, sicker beneficiaries might move to Fee-for-Service and beneficiaries might have to pay more to stay with a preferred provider or broader network. If these problems are addressed, we believe that premium support can be a meaningful improvement to the MA program.

scholarly journals Seroprevalence and Risk Factors of Brucella Infection in Dairy Animals in Urban and Rural Areas of Bihar and Assam, India

2021 ◽  
Vol 9 (4) ◽  
pp. 783
Author(s):  
Ram Pratim Deka ◽  
Rajeswari Shome ◽  
Ian Dohoo ◽  
Ulf Magnusson ◽  
Delia Grace Randolph ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rural Areas ◽  
Urban Areas ◽  
Control Program ◽  
Cross Sectional Study ◽  
Enzyme Linked Immunosorbent Assay ◽  
Cross Sectional ◽  
Brucella Infection ◽  
Multi Stage ◽  
Dairy Animals

This study assessed seropositivity of Brucella infection in dairy animals and risk factors associated with it. The cross-sectional study used multi-stage, random sampling in the states of Bihar and Assam in India. In total, 740 dairy animals belonging to 534 households of 52 villages were covered under this study. Serological testing was conducted by indirect enzyme-linked immunosorbent assay (iELISA). Animal-level Brucella seropositivity was found to be 15.9% in Assam and 0.3% in Bihar. Seropositivity in urban areas (18.7%) of Assam was found to be higher than in rural areas (12.4%). Bihar was excluded from the risk factor analysis, as only one Brucella seropositive sample was detected in the state. A total of 30 variables were studied for assessing risk factors, of which 15 were selected for multivariable regression analyses following a systematic process. Finally, only three risk factors were identified as statistically significant. It was found that animals belonging to districts having smaller-sized herds were less likely (p < 0.001) to be Brucella seropositive than animals belonging to districts having larger-sized herds. Furthermore, the chance of being Brucella seropositive increased (p = 0.007) with the increase in age of dairy animals, but decreased (p = 0.072) with the adoption of artificial insemination (AI) for breeding. We speculated that the identified risk factors in Assam likely explained the reason behind lower Brucella seropositivity in Bihar, and therefore any future brucellosis control program should focus on addressing these risk factors.

scholarly journals Health Disparities and Access to Healthcare in Rural vs. Urban Areas

2021 ◽  
Vol 14 (2) ◽  
pp. 6-27
Author(s):  
Megan Reilly
Keyword(s):  
Access To Care ◽  
Urban Communities ◽  
Rural Areas ◽  
Urban Areas ◽  
Healthcare Access ◽  
Healthcare Research ◽  
Access To Healthcare ◽  
Rural And Urban Areas ◽  
The North ◽  
Rural And Urban

Individuals and families in rural areas face disparities in health as well as access to healthcare. Research has found that when compared to urban communities, rural areas have worse health outcomes including challenges with mental health, substance abuse, physical health, and sexual health. Relevant findings have also shown that in order to understand these challenges it is important to discuss access, including the different factors involved: availability, affordability, and acceptability. Along with defining access, there are several theories and frameworks that additionally help explain healthcare access in rural areas. Although availability, affordability, and acceptability are important variables when it comes to access, there are also several barriers that must be considered, including poverty, occupation, education, insurance, and lack of competence. Once all of these aspects are addressed, different strategies can be more easily implemented in order to improve health and access to care in rural areas. These different disparities in heath and access to care can be seen throughout the North Country, and can be helpful in understanding the larger pattern of health in rural and urban areas.

An Epidemiological, Diagnostic and Therapeutic Study of Giardia lamblia in Anbar Province – Iraq

2019 ◽  
Vol 9 (01) ◽  
pp. 39-45
Author(s):  
Suad Shallal Shahatha
Keyword(s):  
Teaching Hospital ◽  
Rural Areas ◽  
Giardia Lamblia ◽  
Urban Areas ◽  
Culture Media ◽  
Age Groups ◽  
Stool Samples ◽  
Women And Children ◽  
Teucrium Polium L ◽  
Therapeutic Study

This study was carried out to investigate the epidemiology of Giardia lamblia parasites in patients who visited some of the hospitals in Anbar province, which included (Fallujah Teaching Hospital, Ramadi Teaching Hospital, Ramadi Teaching Hospital for Women and Children and Hit Hospital) during by examining 864 stool samples in a direct examination method, The results revealed the infection rate was 41.7 % and the percentage of infection among males 47.8% is higher than that of females 35.4% with significant differences (p≤0.05). The age groups (1-9) years recorded the highest rates 55.4% and the lowest rate 13.6% in the age group (40-49) years. The highest rate of infection was 62.5% during the month of June, while the month of October was the lowest rate 5% and significant differences. The incidence rate in rural areas was 50.6% higher than in the urban areas 32.5%. The study also included the effect of Teucrium polium L. on the parasite in the culture media HSP-1, the concentrations of 0.5-3 mg / mL significantly affected Giardia, it was noted whenever the greater the concentration, the greater the effect during different treatment periods (1-4) days, as the highest concentration 3 mg/ml killed all Giardia parasites on the fourth day of treatment.

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