Articles de revues : « Barriers to health insurance »

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Sharma, Kavita, Lynn Tepper et Carol Kunzel. « BARRIERS TO ORAL HEALTH IN THE OLDER POPULATION ». Innovation in Aging 3, Supplement_1 (novembre 2019) : S878. http://dx.doi.org/10.1093/geroni/igz038.3218.

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Abstract A strong challenge is posed for patients and their caretakers by the growing need for promoting oral healthcare for this population, as research substantiates the connection between oral health and systemic health. This study identified the major barriers to providing optimal oral care to the older population. Fifty patients aged 60 and over visiting the Columbia University College of Dental Medicine Clinic were administered a questionnaire which reflected possible barriers to oral health care. Statistical analysis of data revealed that the top three barriers in order of relevance were the (1) cost of treatment, (2) anxiety, and (3) transportation. The youngest old (60-69) indicated that the lack of time and conflict with work schedules were additional barriers, while the older sample (70+) experienced obstacles due to disability and illness. When gender differences were analyzed, transportation was the most significant as a barrier among males, and fear/anxiety was most significant for females. Ethnically, non-Hispanics indicated that (1) shortage of time, (2) anxiety, and (3) lack of social/physical support were significant barriers. Findings indicated that even those with Medicaid insurance coverage believed that the cost of dental treatment and caregiving responsibilitieswere major barriers to seeking care. Conversely, even those without dental insurance indicated that disability and illness were barriers to seeking care. This pilot study highlighted various barriers to oral health care and highlighted the need for intervention to address barriers, such as social services, expanded Medicaid coverage, and transportation assistance, to ultimately improve access to optimal oral health care.

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Lim, Sylvia W., Rosy Chhabra, Ayelet Rosen, Andrew D. Racine et Elizabeth M. Alderman. « Adolescents’ Views on Barriers to Health Care ». Journal of Primary Care & ; Community Health 3, n^o 2 (30 novembre 2011) : 99–103. http://dx.doi.org/10.1177/2150131911422533.

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Objectives: To determine from adolescents using health care their: 1) perceptions of barriers to obtaining health services, 2) views on how to overcome the barriers and 3) views on how to create an adolescent-friendly primary care practice. Design: Six focus group interviews. Methods: Adolescents 11-21 years old from three health centers in the Bronx were recruited. Main Outcome Measures: 1) barriers to accessing health care such as insurance, language barriers, transportation, making an appointment; 2) identifying barriers related to issues of consent and confidentiality; 3) exploring barriers to accessing mental health and related issues; and 4) their visions of an adolescent-friendly office. Results: Thirty-one adolescents, aged 11-21 years old, participated. The majority were Hispanic and 52% were female. Fifty percent of adolescents had a routine visit within the past month. Most adolescents reported experiencing barriers to making an appointment. Additionally, they complained about long waiting times to be seen by providers on the day of their scheduled appointment. Another key barrier was related to knowledge and perceptions about consent and confidentiality. Further, in regard to mental health, many adolescents from focus groups reported that they felt that their primary providers had little interest in this topic and limited knowledge about it. Most of the adolescents reported no barriers with insurance, language or transportation. Their visions of an adolescent-friendly office would include a separate adolescent waiting area equipped with entertainment units. Conclusion: In this study of adolescents who already have primary care providers and are seemingly well-connected to the health care system, there remained significant reported barriers to accessing necessary health services.

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Raadabadi, Mehdi, Mohammadkarim Bahadori, Ramin Ravangard et Khalil Alimohammadzadeh. « Barriers to the Use of Management Information System (MIS) in the Health Insurance Organizations : A Case Study of Iran ». Journal of Health Management 20, n^o 4 (24 octobre 2018) : 427–38. http://dx.doi.org/10.1177/0972063418799164.

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The use of information technology (IT) is essential in the insurance industry for reducing the risks and managing the affairs, and this industry needs to be equipped with IT in order to stay competitive. In this regard, identifying the barriers to the use of IT in the insurance industry can provide great opportunities for improving its performance and help to develop appropriate strategies. This study aimed to investigate the barriers to the use of the management information system in the health insurance organizations in Ilam. This was an applied, cross-sectional and analytical-descriptive study conducted in the health insurance organizations in Ilam, Iran, in 2015, in which all managers and employees of health insurance organizations were studied using census method ( n = 200). The required data were collected using a questionnaire to investigate six dimensions, including environmental, human, cultural, organizational, technological and managerial barriers. The collected data were analysed using SPSS 19.0. Moreover, the method used to examine the barriers in this study was structural equation modeling which was performed using AMOS. The results showed that among the six dimensions of barriers to the use of IT, the highest and lowest means were related to the cultural factors (3.94 ± 0.53) and the environmental factors (2.8 ± 0.94), respectively. Also, the cultural barriers (regression weight = 0.11) and environmental barriers (regression weight = 0.94) had the highest and lowest effects, respectively. According to the results of the present study, the cultural barriers were the most important ones to the use and implementation of IT. Notifying the use and development of IT in the insurance organizations, holding conferences aimed at presenting the latest achievements and using qualified persons for providing practical IT training are a few effective ways of overcoming the cultural barriers.

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Valencia-Castro, P., A. Stachnik, D. Fuentes, G. Gaitan, W. Yang et J. Smith-Gagen. « Barriers to Health Care Among Parents Using Children's Health Insurance Program ». Annals of Epidemiology 20, n^o 9 (septembre 2010) : 710. http://dx.doi.org/10.1016/j.annepidem.2010.07.057.

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McDoom, M. Maya, Elisa Koppelman et Mari-Lynn Drainoni. « Barriers to Accessible Health Care for Medicaid Eligible People With Disabilities ». Journal of Disability Policy Studies 25, n^o 3 (27 décembre 2012) : 154–63. http://dx.doi.org/10.1177/1044207312469829.

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People with disabilities (PWD) are more likely than those without disabilities to experience barriers when accessing healthcare, often leading to unmet needs. The chasm between what providers perceive as adequate care for PWD and the actual health care needs as perceived by PWD remains significant. Using data from 360 health care providers and 540 Medicaid eligible PWD, we compared perceived barriers to care faced by PWD from the perspective of both providers and PWD. Our results indicated major variations in provider and PWD perceptions about barriers to care. PWD and providers both perceived transportation issues as the highest ranked barriers and physical access issues as the lowest ranked barriers. Multivariate results indicated that PWD reported barriers when communicating with providers, although providers did not consider communication as a major barrier. Among PWD, those with multiple types of disabilities were more likely to experience barriers when communicating with providers compared with other PWD. In addition, providers considered insurance a barrier to care, although this was not the perception of PWD. Particularly in the era of health care reform, policy responses to these findings should address the specific needs of people with different types of disabling conditions rather than assuming all PWD face similar challenges in accessing and utilizing health care.

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Maiden, Robert J., Danielle Gagne, Daniel l. Segal et Bert Hayslip Jr. « IDENTIFYING BARRIERS TO MENTAL HEALTH SERVICES IN A RURAL COMMUNITY ». Innovation in Aging 3, Supplement_1 (novembre 2019) : S553. http://dx.doi.org/10.1093/geroni/igz038.2037.

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Abstract Unmet mental health care needs of older people living in rural areas have been identified as a fundamental problem. This project engaged a rural consortium of service agencies to support recruitment through advertising, word of mouth, social media. So far, 100 rural participants aged 50 and older have completed our survey which includes the revised Barriers to Mental Health Services Scale, (BMHSS-R) which measures intrinsic barriers attributed to internal characteristics and beliefs, e.g. stigma, and extrinsic barriers, e.g. insurance costs, and lack of transportation. Preliminary results revealed increased services utilization compared to past research. However, several serious barriers remained, e.g. as lack of insurance/costs, distance/location, stigma, and lack of knowledge. The BMHSS-R results e demonstrate how the two types of barriers are related and interact within individuals. Implications are that internal barriers (e.g., stigma) and external ones (location, costs) can be reduced or eliminated through integrated medical/behavioral services.

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Naing, Sa Hlyan Htet, Sang-Arun Isaramalai et Phen Sukmag. « Policy Literacy, Barriers, and Gender Impact on Accessibility to Healthcare Services under Compulsory Migrant Health Insurance among Myanmar Migrant Workers in Thailand ». Journal of Environmental and Public Health 2020 (29 décembre 2020) : 1–8. http://dx.doi.org/10.1155/2020/8165492.

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Accessibility to health service and experience of healthcare are important factors for public health policymaking. The current study aimed to describe the status of accessibility and barriers to getting care as well as policy literacy among Myanmar migrant workers and ultimately to identify the predictors of accessibility to healthcare services among this population through Thailand’s Compulsory Migrant Health Insurance (CMHI). A cross-sectional survey was used to collect data from 240 Myanmar migrant workers who were 18 years or older, resided in Songkhla Province, and had Compulsory Migrant Health Insurance. The instrument was a set of questionnaires consisting of a Personal Data Form, Policy Literacy Questionnaire, Barriers to Get Care Questionnaire, and Accessibility to Healthcare Services Questionnaire. Descriptive statistics, correlation analysis, and multiple regression analysis were used to analyze data. The majority of participants had a high level of policy literacy (36.3%), barriers to get care (34.2%), and accessibility to health care services (35.8%). Policy literacy (β = 0.35, p < 0.001 ), barriers to get care (β = −0.32, p < 0.001 ), and gender ( p < 0.001 ) were significant predictors of accessibility to healthcare services and could explain 43.2% of the total variance. To increase the accessibility to healthcare services among migrant workers with Compulsory Migrant Health Insurance, public health policymakers are recommended to cooperate more with healthcare staff and the workers’ employers to enhance the distribution of information about the health insurance to decrease barriers to get care.

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Fayanju, Oluwadamilola M., Susan Kraenzle, Bettina F. Drake, Xuemei Si, Masayoshi Oka et Melody S. Goodman. « Barriers to mammography among underserved women in a breast health center outreach program. » Journal of Clinical Oncology 30, n^o 27_suppl (20 septembre 2012) : 13. http://dx.doi.org/10.1200/jco.2012.30.27_suppl.13.

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13 Background: An outreach registry of Breast Health Center patients was developed in 2006 to evaluate the effectiveness of mobile mammography among the medically underserved. Registry included collection of medical record data, demographic data, and answers to a questionnaire about perceptions of breast cancer screening. Here, we examine barriers to mammography. Methods: Between April 2006 and May 2011, 9,082 women were registered. Data from registrants’ first screening visit (n= 8,916) were analyzed using multivariable logistic regression examining three outcomes identified as barriers to mammography: cost, fear of pain during the procedure, and fear of receiving bad news. Two-tailed p<0.05 was considered significant. Results: The majority of registrants were black (54%), uninsured (74%), screened on a van (83%), resided in the greater St. Louis region (84%), had an annual income <$20,000 (87%), and reported a good or excellent experience as part of the outreach program (92%). Fears of cost, mammogram-related pain, and bad news were reported by 40%, 13%, and 13% of registrants, respectively. Regression analyses revealed that being employed (odds ratio [OR] 1.109, p=0.0323) and living in the Bootheel of Missouri (OR 2.319, p<0.0001) were associated with a higher likelihood of perceiving cost as a barrier to mammography, while those who had insurance (OR 0.439) and were Hispanic (compared to non-Hispanic [NH] whites [OR 0.338]) were less likely to report cost as a barrier (both p<0.0001). Registrants who were screened on the van (OR 1.633), had insurance (OR 1.391), and were NH black (OR 1.324) were more likely to report fear of procedural pain as a barrier (all p<0.0001). Having insurance (OR 1.378), being NH black (OR 2.458), and being Hispanic (OR 2.980) were associated with reporting fear of receiving bad news as a barrier (all p>0.0001), while older women (OR 0.985, p=0.0001) and women who were screened on the van (OR 0.772, p=0.0026) were less likely to report this concern. Conclusions: Despite provision of free services, cost, fear of procedural pain, and fear of abnormal results remain barriers to mammography utilization among medically underserved women, suggesting the need for more breast health education in this population.

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Koijen, Ralph S. J., et Stijn Van Nieuwerburgh. « Combining Life and Health Insurance* ». Quarterly Journal of Economics 135, n^o 2 (30 octobre 2019) : 913–58. http://dx.doi.org/10.1093/qje/qjz037.

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Abstract We estimate the benefit of life-extending medical treatments to life insurance companies. Our main insight is that life insurance companies have a direct benefit from such treatments because they lower the insurer’s liabilities by pushing the death benefit further into the future and raising future premium income. We apply this insight to immunotherapy, treatments associated with durable gains in survival rates for a growing number of cancer patients. We estimate that the life insurance sector’s aggregate benefit from FDA-approved immunotherapies is $9.8 billion a year. Such life-extending treatments are often prohibitively expensive for patients and governments alike. Exploiting this value creation, we explore various ways life insurers could improve stress-free access to treatment. We discuss potential barriers to integration and the long-run implications for the industrial organization of life and health insurance markets, as well as the broader implications for medical innovation and long-term care insurance markets.

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Banerjee, Abhijit, Amy Finkelstein, Rema Hanna, Benjamin A. Olken, Arianna Ornaghi et Sudarno Sumarto. « The Challenges of Universal Health Insurance in Developing Countries : Experimental Evidence from Indonesia’s National Health Insurance ». American Economic Review 111, n^o 9 (1 septembre 2021) : 3035–63. http://dx.doi.org/10.1257/aer.20200523.

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To investigate barriers to universal health insurance in developing countries, we designed a randomized experiment involving about 6,000 households in Indonesia who are subject to a government health insurance program with a weakly enforced mandate. Time-limited subsidies increased enrollment and attracted lower-cost enrollees, in part by reducing the strategic timing of enrollment to correspond with health needs. Registration assistance also increased enrollment, but increased attempted enrollment much more, as over one-half of households who attempted to enroll did not successfully do so. These findings underscore how weak administrative capacity can create important challenges in developing countries for achieving widespread coverage. (JEL D82, G22, H51, I13, I18, O15)

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Pajarillo, Carmen, Ronald A. Sherman, Robert Sheridan et Lewis E. Kazis. « Health professionals' perceptions of maggot debridement therapy ». Journal of Wound Care 30, Sup9a (2 septembre 2021) : VIIi—VIIxi. http://dx.doi.org/10.12968/jowc.2021.30.sup9a.vii.

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Background: Maggot debridement therapy (MDT), or the use of maggots in dead tissue removal, has been shown to be beneficial in wound healing. Yet MDT in the US is often only used once conventional debridement methods have failed. Method: In this study, nine health professionals, experienced in MDT, were interviewed in order to identify and analyse the perceived societal barriers to MDT acceptance and usage in the US. Results: Through qualitative analysis, using the grounded theory framework, this study found that among those interviewed, insurance reimbursement restrictions and stigmatisation of medicinal maggots were the factors driving resistance to MDT use. Conclusion: Specifically, the ‘yuck’ factor and the perception of MDT as an ‘ancient’ modality contributed towards MDT stigma; in addition, lack of outpatient insurance coverage deterred MDT use. These findings provide useful information regarding the perceptual and systemic barriers that prevent greater acceptance of MDT. Ultimately, these barriers must be understood if we are to facilitate MDT implementation and improve MDT usage in the future.

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Kempe, Allison, Brenda L. Renfrew, Jennifer Barrow, Darci Cherry, Jennifer S. Jones et John F. Steiner. « Barriers to Enrollment in a State Child Health Insurance Program ». Ambulatory Pediatrics 1, n^o 3 (mai 2001) : 169–77. http://dx.doi.org/10.1367/1539-4409(2001)001<0169:bteias>2.0.co;2.

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Jae Bok, Lee, Roh Chul-young et Woolley Jonathan A. « Heterogeneous Impact of Geographic Barriers on Provider Choice Evidence from New York County’s Health Market ». Korean Journal of Policy Studies 33, n^o 3 (31 décembre 2018) : 23–45. http://dx.doi.org/10.52372/kjps33302.

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Health services should be accessible regardless of citizens’ gender, age, race, or insurance type, and geographic barriers should not interfere with this access. This article aims to assess the heterogeneous impacts of geographic barriers on inpatients’ hospital choices and to examine whether they vary according inpatients’ socioeconomic or insurance status. Using data on providers and inpatients obtained from the New York State Bureau of Health Informatics Office of Quality and Patient Safety for New York County (New York City’s borough of Manhattan) for 2009, we employed a discrete choice model. Our findings reveal that geographic barriers limit inpatients’ choices of hospitals more when they are of low socioeconomic status.

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Garney, Whitney, Kelly Wilson, Kobi V. Ajayi, Sonya Panjwani, Skylar M. Love, Sara Flores, Kristen Garcia et Christi Esquivel. « Social-Ecological Barriers to Access to Healthcare for Adolescents : A Scoping Review ». International Journal of Environmental Research and Public Health 18, n^o 8 (14 avril 2021) : 4138. http://dx.doi.org/10.3390/ijerph18084138.

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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.

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Yarborough, Mark. « The Private Health Insurance Industry : The Real Barrier to Healthcare Access ? » Cambridge Quarterly of Healthcare Ethics 3, n^o 1 (1994) : 99–107. http://dx.doi.org/10.1017/s0963180100004771.

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Any humane society needs a just and compassionate way to care for those who are sick, and should be vigilant in identifying and eliminating barriers that frustrate efforts to adequately care for the sick. Some current insurance underwriting practices constitute effective barriers to access to healthcare and serve to diminish the place of freedom and justice in our healthcare system.

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Alberto, Cinthya K., Jessie Kemmick Pintor, Ryan M. McKenna, Dylan H. Roby et Alexander N. Ortega. « Racial and Ethnic Disparities in Provider-Related Barriers to Health Care for Children in California After the ACA ». Global Pediatric Health 6 (janvier 2019) : 2333794X1982835. http://dx.doi.org/10.1177/2333794x19828356.

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The aim of this study was to examine disparities in provider-related barriers to health care by race and ethnicity of children in California after the implementation of the Affordable Care Act (ACA). California Health Interview Survey child (0-11 years) survey data from 2014 to 2016 were used to conduct multivariable logistic regressions to estimate the odds of reporting any provider-related barrier, trouble finding a doctor, child’s health insurance not accepted by provider, and child not being accepted as a new patient. Compared with parents of non-Latino white children, parents of non-Latino black, Latino, Asian, and other/multiracial children were not more likely to report experiencing any of the 4 provider-related barrier measures. The associations between children’s race and ethnicity and parents’ reports of provider-related barriers were nonsignificant. Findings demonstrate that there are no significant racial/ethnic differences in provider-related barriers to health care for children in California in the post-ACA era.

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Kansra, Pooja, et Gaurav Pathania. « A study of factor affecting the demand for health insurance in punjab ». Journal of Management and Science 1, n^o 4 (30 décembre 2012) : 281–90. http://dx.doi.org/10.26524/jms.2012.37.

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The economic status of a country is directly related to the health status of its people. Goodhealth is one of the most important pre-requisite to human productivity which in turn leads to overalldevelopment of a society. Health is understood as the indispensable basis for defining a person‟s sense ofwell-being. It is an important resource for a nation to pursue national development goals. It raises theproductivity of the labor force and enhances economic growth. It plays a critical role in supplementinggovernment effort in ensuring the availability and accessibility of health care services to the population. Theobjective of the present paper is to know the awareness of health insurance and the factors affecting thedemand for health insurance in Punjab. For the analysis of data descriptive statistics and factor analysis havebeen applied. The sample size is 200 residents of Jalandhar chosen according to convenience approach. Thestudy highlighted that majority of the people aware of the health insurance, Only 11.5 % of the total samplehas subscribed for health insurance scheme and five factors i.e. formalities bottlenecks, agent relatedproblems, coverage issues, awareness, negative feedback are main barriers in the success of health insurancein Punjab

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Julchoo, Sataporn, Nareerut Pudpong, Mathudara Phaiyarom, Pigunkaew Sinam, Anon Khunakorncharatphong et Rapeepong Suphanchaimat. « Health Status and Barriers to Healthcare Access among “Son-in-Law Westerners” : A Qualitative Case Study in the Northeast of Thailand ». International Journal of Environmental Research and Public Health 18, n^o 21 (20 octobre 2021) : 11017. http://dx.doi.org/10.3390/ijerph182111017.

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The northeast of Thailand is well-known as a popular destination where many male Westerners marry Thai women and settle down there. However, little is known about their health and well-being. This study aims to explore the Western husbands’ health status and identify barriers hindering their healthcare access. A qualitative case study was conducted from November 2020 to May 2021. In-depth interviews and focus group discussions with 42 key informants who were involved with social and health issues among these expatriates were carried out. The social determinants framework was adapted for guiding the interviews. Data were triangulated with field notes, document reviews, and researchers’ observations. Inductive thematic analysis was applied. Results showed that most male expatriates who married Thai women in the northeast were in their retirement years and had non-communicable diseases, health risk behaviors, and mental health problems. Most of them did not purchase health insurance and held negative impressions toward Thai public hospitals’ quality of care, which was denoted as the main barrier to accessing healthcare services. Other significant barriers consisted of high treatment costs commonly charged by private hospitals and language issues. While the improvement of healthcare quality and the provision of friendly health services are important, public communication with foreign residents, especially male expatriates, is recommended to increase understanding and improve perceptions of the Thai healthcare systems. A regular population-based survey on the health and well-being of expatriates in Thailand, a cost study of a health insurance package, a survey study on willingness to pay for health insurance premiums, and a feasibility survey exploring the opportunity to establish either voluntary or compulsory health insurance among this group should be undertaken.

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Mackert, Michael, Hyeseung E. Koh, Amanda Mabry-Flynn, Sara Champlin et Anna Beal. « Domestic and International College Students : Health Insurance Information Seeking and Use ». Journal of International Students 7, n^o 3 (1 juillet 2018) : 542–61. http://dx.doi.org/10.32674/jis.v7i3.287.

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This study aimed to explore perceived barriers to using health insurance and identify discriminant factors between health insurance information seekers and non-seekers. A total of 615 domestic and international college students from a large university in the Southwest completed a cross-sectional survey. Findings imply that campus health providers and staff in international student services should be working closely to communicate to students about health insurance because they are both trying to solve the same basic problems.

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Purcell, Maureen, Rustin Reeves et Matthew Mayfield. « Examining delays in diagnosis for slipped capital femoral epiphysis from a health disparities perspective ». PLOS ONE 17, n^o 6 (24 juin 2022) : e0269745. http://dx.doi.org/10.1371/journal.pone.0269745.

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Slipped Capital Femoral Epiphysis (SCFE) is a skeletal pathology affecting adolescents which requires timely surgery to prevent progression. Delays in diagnosis and treatment of SCFE can negatively affect patient prognosis, and few studies have examined how health disparities and barriers to care may influence these delays. In particular, only a handful of studies have included a Hispanic patient sample, despite this ethnic group’s increased risk for the disease and unique barriers to care. A retrospective chart review was conducted for 124 patients surgically treated for idiopathic SCFE from January 2010 to September 2017. Patient data included age, facility and date of diagnosis, sex, BMI, race and ethnicity, Southwick slip angle, and insurance type. Results indicated that patients with private insurance were more likely to present with a mild slip than patients who were insured by Medicaid or uninsured, while patients without insurance were more likely to have severe slips. Patients without insurance also had a significantly higher mean slip than patients with insurance. The relationship between insurance status and slip angle degree was significant independent of race, even though Hispanic individuals were significantly more likely to have Medicaid or be uninsured. All patients without insurance, and a majority of those with Medicaid, were diagnosed in the emergency department. Time to diagnosis and slip angle were positively correlated, which suggests that longer delays led to increase of the slip angle, consistent with previous findings. Time to diagnosis and BMI were also correlated, which may be tied to socioeconomic factors, but the possibility of weight bias should not be dismissed. These results suggest that socioeconomic status and other factors may have contributed to barriers to care which led to delays in diagnosis and thus more severe slips. Future SCFE research should include health disparities variables to better inform treatment and prognosis.

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TJ, Caze, Vasquez D, Loveland DM et Burkhart SO. « A - 04 Sociocultural and Health Equity Barriers Influencing Time to Clinic Following Sports-Related Concussion ». Archives of Clinical Neuropsychology 36, n^o 4 (21 mai 2021) : 644. http://dx.doi.org/10.1093/arclin/acab035.04.

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Abstract Objective Given the strong association between time to specialty concussion clinic and recovery, the purpose of this study was to examine sociocultural factors influencing time to clinic. Methods 1001 participants ages 8–18 (M = 14, SD = 2.2) with SRC were seen in a specialty concussion clinic. Groups were divided into early (within 7 days of injury) and delayed (8–20 days) to clinic. Sociocultural factors including race, insurance category of private vs. non-private (i.e., Medicaid and CHIP), and their intersectionality were examined to determine potential differences in access. Results There was a significant difference between insurance category X2(1) =41.37, p < 0.001 and days to clinic, 34.7% of those with non-private insurance compared to 15.7% with private insurance were in the delayed to clinic group. There was a significant difference in insurance category by race X2(6) =253.28, p < 0.001, with Hispanic (60.8%) and Black (50.3%) patients being more likely to have non-private insurance compared to just (9.4%) of White participants. There was a significant difference in days to clinic by race X2(6) =40.02, p < 0.001, with 34.8% of Hispanic and 25.9% of Black participants compared to 14.5% of White participants being in the delayed to clinic group. White males with private insurance on average got to clinic faster (M = 3.78, SD = 3.94) than minority females with non-private insurance (M = 9.04, 4.94). Conclusions Even though early access to a specialty concussion clinic is associated with faster recovery times, there are glaring disparities regarding health equity and whom is getting to clinic early. Further research is needed to help determine ways to minimize these barriers.

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Geyman, John P. « Myths as Barriers to Health Care Reform in the United States ». International Journal of Health Services 33, n^o 2 (avril 2003) : 315–29. http://dx.doi.org/10.2190/flv6-w082-hxf6-bpgq.

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The U.S. health care system is deteriorating in terms of decreasing access, increased costs, unacceptable quality, and poor system performance compared with health care systems in many other industrialized Western countries. Reform efforts to establish universal insurance coverage have been defeated on five occasions over the last century, largely through successful opposition by pro-market stakeholders in the status quo. Reform attempts have repeatedly been thwarted by myths perpetuated by stakeholders without regard for the public interest. Six myths are identified here and defused by evidence: (1) “Everyone gets care anyhow;” (2) “We don't ration care in the United States”; (3) “The free market can resolve our problems in health care”; (4) “The U.S. health care system is basically healthy, so incremental change will address its problems;” (5) “The United States has the best health care system in the world”; and (6) “National health insurance is so unfeasible for political reasons that it should not be given serious consideration as a policy alternative.” Incremental changes of the existing health care system have failed to resolve its underlying problems. Pressure is building again for system reform, which may become more feasible if a national debate can be focused on the public interest without distortion by myths and disinformation fueled by defending stakeholders.

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Maness, Sarah B., Jonathan H. Low et Tony Vu. « A Qualitative Analysis of Access to Healthcare Among African American Adults in South Carolina ». Journal of Primary Care & ; Community Health 14 (janvier 2023) : 215013192311535. http://dx.doi.org/10.1177/21501319231153593.

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Access to healthcare is a Social Determinant of Health that is associated with public health outcomes and barriers to access disproportionately affect African American adults. This study used a health and financial literacy approach to qualitatively assess how African American adults access healthcare and potential barriers faced (n = 20). Results indicated a wide range of experiences generally split between positive and negative experiences in access to healthcare. Specific themes that emerged included scheduling issues and appointment availability, expense of care, lack of transparency in insurance coverage, the need for more primary care clinics and enhanced community outreach and education on how to access healthcare. This research identifies a need for increased education surrounding health insurance coverage and an identified need for more local physicians or ease of scheduling. All participants in this study stated they were covered by health insurance of some form. Future research should examine these issues in the context of socioeconomic and insurance status.

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Champlin, Sara, et Juli James. « Breaking Health Insurance Knowledge Barriers Through Games : Pilot Test of Health Care America ». JMIR Serious Games 5, n^o 4 (16 novembre 2017) : e22. http://dx.doi.org/10.2196/games.7818.

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Sanford, Nina Niu, Miranda Lam, David J. Sher, Santino Butler, Chul Ahn, Ayal Aaron Aizer et Brandon Arvin Virgil Mahal. « Rates and patterns of uninsured cancer survivors before and after implementation of the Affordable Care Act, 2000-2017. » Journal of Clinical Oncology 37, n^o 15_suppl (20 mai 2019) : e18105-e18105. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18105.

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e18105 Background: Cancer survivors experience difficulties in maintaining healthcare coverage, however the reasons and risk factors for lack of insurance are poorly defined. We sought to assess self-reported reasons for not having insurance and to assess demographic and socioeconomic factors associated with non-insurance among cancer survivors, before and after implementation of the Affordable Care Act (ACA) in 2014. Methods: We used the National Health Interview Survey to identify adult participants (18-64 years) reporting a cancer diagnosis between 2000-2017. Multivariable logistic regression was used to define the association between demographic and socioeconomic variables and odds being uninsured. The prevalence of the most common self-reported reasons for not having insurance (unemployment, employment-related reason, family-related) were estimated, with AORs for each of the reasons defined by multivariable logistic regression. Results: Among 17,806 survey participants, 10.3% reported not having health insurance. Individuals surveyed in 2000-2013 had higher odds of not having insurance as compared to those surveyed in 2014-2017 (10.6% vs. 6.2%, AOR 1.75, 95% CI 1.49-2.08). Variables associated with higher odds of non-insurance throughout the entire study interval included younger age, annual family income below the poverty threshold, black race, Hispanic ethnicity, non-citizen status and current smoking (p < 0.001 for all). After implementation of the ACA, increasing interval from cancer diagnosis and black race were no longer associated with not having insurance. The most commonly cited reason for not having insurance were cost followed by unemployment, both of which decreased after ACA implementation (cost: 49.6% vs. 37.6%, AOR 0.62, 95% CI 0.46-0.85; unemployment: 37.1% vs. 28.5%, AOR 0.62, 95% CI 0.45-0.87). Conclusions: The proportion of uninsured cancer survivors decreased after implementation of the ACA, however certain subgroups remain at greater risk of being uninsured. Cost remains the primary barrier to obtaining insurance, although more than half of cancer survivors reported other barriers to coverage. Given the growing number of cancer survivors in conjunction with rising health costs, efforts addressing barriers to insurance coverage are needed for this population.

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Umar, Suraiya, Adam Fusheini et Martin Amogre Ayanore. « The shared experiences of insured members and the uninsured in health care access and utilization under Ghana’s national health insurance scheme : Evidence from the Hohoe Municipality ». PLOS ONE 15, n^o 12 (23 décembre 2020) : e0244155. http://dx.doi.org/10.1371/journal.pone.0244155.

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Background The National Health Insurance Scheme (NHIS) was introduced in Ghana in 2003 to remove financial barriers and to promote equitable access to health care services. Post implementation has been characterized by increases in access and utilization of services among the insured. The uninsured have been less likely to utilize services due to unaffordability of health care costs. In this study, we explored the experiences of the insured members of the NHIS, the uninsured and health professionals in accessing and utilizing health care services under the NHIS in the Hohoe Municipality of Ghana. Methods Qualitative in-depth interviews were held with twenty-five NHIS insured, twenty-five uninsured, and five health care professionals, who were randomly sampled from the Hohoe Municipality to collect data for this study. Data was analyzed using thematic analysis. Results Participants identified both enablers or motivating factors and barriers to health care services of the insured and uninsured. The major factors motivating members to access and use health care services were illness severity and symptom persistence. On the other hand, barriers identified included perceived poor service quality and lack of health insurance among the insured and uninsured respectively. Other barriers participants identified included financial constraints, poor attitudes of service providers, and prolonged waiting time. However, the level of care received were reportedly about the same among the insured and uninsured with access to quality health care much dependent on ability to pay, which favors the rich and thereby creating inequity in accessing the needed quality care services. Conclusion The implication of the financial barriers to health care access identified is that the poor and uninsured still suffer from health care access challenges, which questions the efficiency and core goal of the NHIS in removing financial barrier to health care access. This has the potential of undermining Ghana’s ability to meet the Sustainable Development Goal 3.8 of universal health coverage by the year 2030.

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TC, Hsieh. « Employer Health Plan Exclusions are a Barrier to Access of Penile Implants for Erectile Dysfunction ». Open Access Journal of Urology & ; Nephrology 7, n^o 3 (12 juillet 2022) : 1–6. http://dx.doi.org/10.23880/oajun-16000213.

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Introduction: Many commercial insurers and Medicare have published coverage policies detailing the medical necessity and accessibility of erectile dysfunction (ED) treatment, including implantable penile prosthesis (IPP). Approximately 61% of adults aged 18–64 years in the United States (US) receive health benefits via employer-sponsored health plans (ESHP) and 23% of employers reported medical benefit exclusion for sexual dysfunction treatment. Objective: To obtain nationwide US estimates of the proportions of patients denied IPP treatment due to ESHP exclusions (overall and by state, healthcare insurer, and labor sector industry). Methods: De-identified data from an industry IPP insurance benefit verification database from October 1, 2018 to December 31, 2021 were analyzed to evaluate ESHP-related barriers to IPP access. Results: Among 2,638 patients with commercial insurance and employer data, 34.0% were denied IPP treatment due to ESHP benefit exclusions. ESHPs in Washington (60.7%), Louisiana (55.4%), Arizona (46.6%), Nebraska (45.5%), Ohio (43.3%), and Georgia (43.1%) had the highest exclusion rates, whereas Iowa (19.0%), Alabama (18.9%), Maryland (17.3%), Rhode Island (13.0%), and New York (7.1%) had the lowest exclusion rates. Patients with Aetna insurance had the greatest proportion of exclusions (62.4%), followed by Cigna (61.0%), employer-owned health plans (47.2%), other commercial plans (41.8%), Anthem (37.3%), Blue Cross Blue Shield (BCBS) state plans (24.1%), United Healthcare (15.4%), and Humana (0.0%). The exclusion rate was highest for employees of the leisure and hospitality industry (51.9%), followed by religious organizations (50.0%), health care (40.5%), construction, mining, or agriculture (39.1%), education (38.9%), retail and wholesale trade (36.9%), manufacturing (36.7%), utilities (36.2%), professional and business services (35.4%), transportation (32.6%), finance and insurance (29.1%), labor union organizations (26.9%), and finally public, state, and government administration (25.1%). Conclusions: Despite insurance carrier medical policies, 34.0% of men with an ESHP are denied access to IPP ED treatment due to their ESHP benefit exclusions. ESHP exclusion rates varied geographically, by insurer, and by labor sector industry.

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Perreira, Krista M., Chenoa D. Allen et Jonathan Oberlander. « Access to Health Insurance and Health Care for Hispanic Children in the United States ». ANNALS of the American Academy of Political and Social Science 696, n^o 1 (juillet 2021) : 223–44. http://dx.doi.org/10.1177/00027162211050007.

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Health insurance gives families access to medical services and protects them against the costs of illness and medical treatment. Insured children are more likely than their uninsured peers to use medical services, preventive health services, have a usual source of care, and have fewer unmet medical needs. In this article, we review trends in health insurance coverage for Hispanic children and the factors that influence their coverage. We then discuss health care utilization among Hispanic children and barriers to health care utilization. We conclude with a discussion of strategies to improve Hispanic children’s health care access in the age of COVID-19.

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Thomas, Susan, Sharmada Sivaram, Zubin Shroff, Ajay Mahal et Sapna Desai. « ‘We are the bridge’ : an implementation research study of SEWA Shakti Kendras to improve community engagement in publicly funded health insurance in Gujarat, India ». BMJ Global Health 7, Suppl 6 (septembre 2022) : e008888. http://dx.doi.org/10.1136/bmjgh-2022-008888.

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IntroductionIndia’s efforts towards universal health coverage include a national health insurance scheme that aims to protect the most vulnerable from catastrophic health expenditure. However, emerging evidence on publicly funded health insurance, as well as experience from community-based schemes, indicates that women face specific barriers to access and utilisation. Community engagement interventions have been shown to improve equitable utilisation of public health services, but there is limited research specific to health insurance. We examined how existing community-based resource centres implemented by a women’s organisation could improve women’s access to, and utilisation of, health insurance.MethodsWe conducted an implementation research study in Gujarat, India to examine how SEWA Shakti Kendras, established by the Self-Employed Women’s Association, worked to improve community engagement in health insurance. SEWA organises women in the informal sector and provides social protection through health, insurance and childcare services. We examined administrative data, programme reports and conducted 30 in-depth qualitative interviews with users and staff. Data were analysed thematically to examine intervention content, context, and implementation processes and to identify enablers and barriers to improving women’s access to health insurance through SEWA’s community engagement approach.ResultsThe centres worked through multiple channels—doorstep services, centre-based support and health system navigation—to strengthen women’s capability to access health insurance. Each centre’s approach varied by contextual factors, such as women’s digital literacy levels and rural–urban settings. Effective community engagement required local leadership, strong government partnerships and the flexibility to address a range of public services, with implementation by trusted local health workers.ConclusionSEWA Shakti Kendras demonstrate how a local, flexible and community-based model can serve as a bridge to improve utilisation of health insurance, by engaging women and their households through multiple channels. Scaling up this approach will require investing in partnerships with community-based organisations as part of strategies towards universal health coverage.

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Huang, Zuyu, et Zehan Pan. « Improving migrants’ access to the public health insurance system in China : A conceptual classification framework ». Asian and Pacific Migration Journal 26, n^o 2 (30 avril 2017) : 274–84. http://dx.doi.org/10.1177/0117196817705779.

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Although the Chinese government has established a public health insurance system covering both rural and urban areas, the rural–urban migrants seem to have been neglected. To have a clear sense of the current status of migrants in the public health insurance system and to find ways to increase their enrollment to medical insurance, this paper attempts to construct a conceptual classification framework of China’s health insurance system. This was done by reviewing the development of China’s health insurance system and identifying barriers to entry for migrants. The finding suggests that migrants’ limited access to health insurance owes more to their reluctance than to system exclusions. The job and residential stability of migrants are critical factors to building the classification framework to account for supply and demand factors in the formulation of China’s health insurance policy.

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Khanum, A., et A. McDonald. « 280 BARRIERS TO OBTAINING HEALTH INSURANCE : A REALITY OR A MYTH ? » Journal of Investigative Medicine 54, n^o 1 (1 janvier 2006) : S306.3—S306. http://dx.doi.org/10.2310/6650.2005.x0008.279.

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Narasimhan, H., V. Boddu, P. V. Singh, A. Katyal, S. Bergkvist et M. Rao. « The Best Laid Plans : Access to the Rajiv Aarogyasri community health insurance scheme of Andhra Pradesh ». Health, Culture and Society 6, n^o 1 (19 mai 2014) : 85–97. http://dx.doi.org/10.5195/hcs.2014.163.

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This paper is a qualitative assessment of a public health insurance scheme in the state of Andhra Pradesh, south India, called the Rajiv Aarogyasri Community Health Insurance Scheme (or Aarogyasri), using the case-study method. Focusing on inpatient hospital care and especially on surgical treatments leaves the scheme wanting in meeting the health care needs of and addressing the impoverishing health expenditure incurred by the poor, especially those living in rural areas. Though well-intentioned, people from vulnerable sections of society may find the scheme ultimately unhelpful for their needs. Through an in-depth qualitative approach, the paper highlights not just financial difficulties but also the non-financial barriers to accessing health care, despite the existence of a scheme such as Aarogyasri. Narrative evidence from poor households offers powerful insights into why even the most innovative state health insurance schemes may not achieve their goals and systemic corrections needed to address barriers to health care.

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Weil, Alan R. « Expanding Access through Public Coverage : Permitting Families to Use Tax Credits to Buy into Medicaid or SCHIP ». INQUIRY : The Journal of Health Care Organization, Provision, and Financing 38, n^o 2 (mai 2001) : 146–58. http://dx.doi.org/10.5034/inquiryjrnl_38.2.146.

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A new tax credit to help low-income families and individuals purchase health insurance can address the problem of affordability, but will not overcome other barriers these populations face in obtaining coverage. This paper proposes that families have the option of using a new tax credit to buy into a state-administered system such as Medicaid or the State Children's Health Insurance Program. This option has three advantages. First, it allows families to remain with a single health program and health plan as their income fluctuates. Second, it provides an alternative to the complex and confusing individual insurance market. This alternative is community rated, does not use underwriting, and allows health plan behavior to be monitored closely by the state. Third, it allows the state to act as a financial buffer—helping overcome the barrier to participation that cash-flow problems and year-end reconciliation concerns are likely to create among a low-income population. Many people would want to use their tax credit in the private market, but the buy-in option increases the likelihood that the tax credit approach would succeed.

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Saini, Arunima, Monika Agarwal et Amit Kumar. « Health insurance : Uptake, perception and its determinants among health care seekers at a tertiary care hospital in Lucknow, India ». Journal of Community Health Management 9, n^o 4 (15 décembre 2022) : 209–15. http://dx.doi.org/10.18231/j.jchm.2022.039.

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Health Insurance has come to the forefront of Public Health Policy with the launch of Ayushman Bharat. Government spending on health is dismal compared to other countries, even within the same income bracket, and health insurance is being proposed as the way out. Although health insurance is not a new concept, people are still unfamiliar with it. Hence, the present study was conducted to assess the utilization, awareness and perception regarding health insurance policies in patients attending OPD at a Tertiary Care Hospital.It was a cross-sectional study carried out among the patients attending the outpatient department of a Tertiary Care Hospital, Lucknow from October 2020 to January 2021. Study participants were interviewed using a semi-structured questionnaire. The data obtained were analyzed using SPSS version 26. Though the majority (84.3%) of the participants had heard about the existence of health insurance policies, only one-third (33.6%) of the participants were covered under health insurance policy. Inadequate knowledge regarding benefits, low income, preference for other investments, and no felt need were some of the barriers to subscription.Inadequate knowledge regarding health insurance among health care seekers is a major roadblock in the government's ambitious project of Ayushman Bharat and other health insurance schemes. Emphasis should be given to educating the people regarding their rights and the benefits of health insurance.

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Ghimire, Gita Devi, et Suresh Raj Paudel. « Patients’ Satisfaction regarding Treatment and Perceived Barriers : A Study of Social Health Insurance Scheme in Kaski District ». Prithvi Academic Journal 2 (1 mai 2019) : 32–41. http://dx.doi.org/10.3126/paj.v2i0.31504.

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The main objective of this paper is to assess the level of patient satisfaction, to assess barriers faced by users of social health insurance during receiving treatment in the hospital, and to find out the relationship of participants' satisfaction with their selected demographic variables. This paper is a cross-sectional descriptive study and covers 354 samples that were selected by systematic sampling technique. The modified version of Assessment of Patients Satisfaction Scale (SAPS) consisting of seven structured items is used to collect the data through the face to face interview. The results of the study indicated that 158 (44.6%) participants are between the age group of 40-59 years and the majority of them i.e. 232 (65.5%) are females. Out of 354, most of the participants 292 (82.5%) are enrolled in the social health insurance scheme for more than 6 months. The study findings indicated that more than half 186 (52.5%) participants are satisfied, followed by 152 (42.9%) are dissatisfied, and 16(4.5%) of participants are very dissatisfied with the treatment service under the social health insurance respectively. The most common barriers faced by the participants while utilizing the health insurance services are unavailability of necessary drugs, long waiting times, limited opening hours, and complex billing system for insurance patients. Hence, the service availability time should be extended and availability of health personnel, medicines as well as other services should be improved that can increase satisfaction among users of health insurance.

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McElfish, Pearl A., Rachel S. Purvis, Sheldon Riklon et Seiji Yamada. « Compact of Free Association Migrants and Health Insurance Policies : Barriers and Solutions to Improve Health Equity ». INQUIRY : The Journal of Health Care Organization, Provision, and Financing 56 (janvier 2019) : 004695801989478. http://dx.doi.org/10.1177/0046958019894784.

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This commentary outlines the health insurance disparities of Compact of Free Association (COFA) migrants living in the United States. Compact of Free Association migrants are citizens of the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau who can live, work, and study in the United States without a visa. Compact of Free Association migrants make up a significant proportion of the rapidly growing Pacific Islander population in the United States. This article describes the historical and current relationships between the United States and the Compact nations and examines national policy barriers constraining health insurance access for COFA migrants. In addition, the commentary describes the state-level health policies of Arkansas, Hawai’i, and Oregon, which are the states where the majority of COFA migrants reside. Finally, policy recommendations are provided to improve health equity for COFA migrants.

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Goldenberg, Shira M., Shaina Schafers, Maggie Hamel-Smith Grassby, Stefanie Machado, Ruth Lavergne et Mei-ling Wiedmeyer. « ‘We don’t have the right to get sick’ : A qualitative study of gaps in public health insurance among Im/migrant women in British Columbia, Canada ». PLOS Global Public Health 3, n^o 1 (26 janvier 2023) : e0001131. http://dx.doi.org/10.1371/journal.pgph.0001131.

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Globally, the exclusion of im/migrants from public health care systems remains a significant health and human rights issue, calling into question claims of ‘universality’ of public health systems where eligibility for coverage is determined by immigration status. We aimed to describe lived experiences of health insurance coverage and the health and social impacts of gaps in health insurance amongst im/migrant women in British Columbia (BC), Canada. This analysis draws on qualitative in-depth interviews (n = 78) with im/migrant women and im/migrant-focused service providers (n = 10) conducted between July 2018-March 2021 in Metro Vancouver, BC, as part of a larger community-based, mixed-methods study of im/migrants’ health access (IRIS). In contrast to common perceptions of Canada’s health system as ‘universal’, participants faced multifaceted barriers to health insurance and necessary healthcare for themselves and their families following arrival in BC. Narratives highlighted the ways in which ineligibility for public health insurance coverage resulted in unmet needs for essential sexual and reproductive health and preventive care among im/migrant women, children, and families. Participants also described ineligibility for public health insurance as resulting in a high economic burden, and that exclusion from public health insurance perpetuated experiences of discrimination, invisibility, and exclusion from systems of care amongst im/migrant participants. Despite these structural challenges, participant narratives highlighted the crucial role of community-based supports for minimizing harm and navigating oppressive immigration and health systems. Changes to immigration and health policies are required to remove barriers to public health care for im/migrant women and ensure that Canada’s health system is accessible to all. Expanding health insurance options to cover all residents and decoupling health insurance eligibility from immigration status are recommended, alongside implementation of ‘Sanctuary’ policies at the local level.

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Mitchell, Elke, Elan Lazuardi, Emily Rowe, Irma Anintya, Dewa N. Wirawan, Rudi Wisaksana, Yanri W. Subronto, Hellen Dewi Prameswari, John Kaldor et Stephen Bell. « Barriers and Enablers to HIV Care Among Waria (Transgender Women) in Indonesia : A Qualitative Study ». AIDS Education and Prevention 31, n^o 6 (décembre 2019) : 538–52. http://dx.doi.org/10.1521/aeap.2019.31.6.538.

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Transgender women (waria) in Indonesia have high rates of HIV and experience barriers accessing HIV services. This qualitative research explored barriers and facilitators to HIV care among waria in Indonesia. Between 2015 and 2016, 42 participants were involved in focus group discussions and in-depth interviews across three urban sites in Indonesia to examine participants' experiences and views on HIV prevention, testing, treatment initiation, and treatment adherence. Data were analyzed thematically. Barriers to accessing HIV care services included perceptions of health and HIV treatment, confidentiality and stigma concerns, and poor access to health insurance. Facilitators to HIV care included recognition of health and perceived susceptibility, perceptions of treatment benefits and consequences of non-adherence, access to social support, and patient-friendly services. Research findings highlight the importance of improving HIV treatment literacy, safeguarding community responses to addressing HIV vulnerability, addressing confidentiality and stigma issues, ensuring services are transgender-friendly, and increasing health insurance coverage.

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Kelton, Christina M. L., Miriam Levitt et Margaret K. Pasquale. « Barriers to SCHIP enrollment : A cross-county study of the State Children's Health Insurance Program in Pennsylvania ». Politics and the Life Sciences 24, n^o 1-2 (septembre 2005) : 22–31. http://dx.doi.org/10.1017/s0730938400007565.

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BACKGROUND. Enrollment in the State Children's Health Insurance Program (SCHIP), created under the federal Balanced Budget Act of 1997, had a distressingly slow start and varied substantially county-to-county in many states, including Pennsylvania. METHODS. We performed a quantitative county-level analysis of barriers to enrollment in Pennsylvania's Children's Health Insurance Program (CHIP) for the year 2000, seven years after it was implemented and three years after federal SCHIP legislation. Using multivariate regression analysis with a county as the unit of observation, we modeled enrollment in SCHIP as a function of accessibility to health care, availability of clinicians, and community economic health. RESULTS. High clinic density and Medicaid managed-care membership predicted SCHIP enrollment success, while female head-of-household predicted SCHIP enrollment failure. A principal-components factor analysis revealed four underlying barriers to enrollment: accessibility, availability, affordability, and effort. CONCLUSIONS. The most formidable barriers to SCHIP enrollment success in Pennsylvania were not programmatic; they were correlates of poverty itself.

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Li, Henan, Susan L. Parish, Sandra Magaña et Miguel A. Morales. « Racial and Ethnic Disparities in Perceived Barriers to Health Care Among U.S. Adults With Intellectual and Developmental Disabilities ». Intellectual and Developmental Disabilities 59, n^o 1 (1 février 2021) : 84–94. http://dx.doi.org/10.1352/1934-9556-59.1.84.

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Abstract Barriers to health care access can greatly affect one's health status. Research shows that U.S. adults with intellectual and developmental disabilities (IDD) have poor health and face barriers such as long waits for appointments. However, whether barriers differ by race and ethnicity has not been examined. We conducted a secondary data analysis using the 2002–2011 Medical Expenditure Panel Survey dataset, and compared perceived barriers of community-living U.S. adults with IDD in three racial and ethnic groups (White, Black, and Latinx). Specifically, we examined the top reasons for not having usual source of care, delaying or foregoing medical care. For Black and Latinx adults with IDD, the most-mentioned reasons for not having usual source of care, delaying or foregoing medical care were “don't like/don't trust doctors,” “don't use doctors,” and “don't know where to get care.” In comparison, the White adults with IDD group's biggest perceived barriers were location and insurance related. All groups cited that being unable to afford care was a top reason for delaying or foregoing care. Policies/interventions to improve health care access in racial/ethnic minorities with IDD must first address the topic of developing trust between patients and the health professions. Insurance and the rising costs of care are also key areas that need attention.

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Sinha, Tara, M. Kent Ranson, Mirai Chatterjee, Akash Acharya et Anne J. Mills. « Barriers to accessing benefits in a community-based insurance scheme : lessons learnt from SEWA Insurance, Gujarat ». Health Policy and Planning 21, n^o 2 (22 décembre 2005) : 132–42. http://dx.doi.org/10.1093/heapol/czj010.

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Perrin, James M., Sheila R. Bloom, Robert S. Kahn, Stephen Davidson, Bernard Guyer, William Hollinshead, Julius B. Richmond, Paul H. Wise et Deborah Klein Walker. « Health Care Reform and the Special Needs of Children ». Pediatrics 93, n^o 3 (1 mars 1994) : 504–6. http://dx.doi.org/10.1542/peds.93.3.504.

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Health care reform may well address many of the needs of children and adolescents, offering greater emphasis on prevention and providing insurance to the large number of US children currently uninsured. Yet key public health and community health service programs essential to the well being of children and adolescents have gained little attention in the current national health care reform debates. Most discussions focus on insurance and cost containment and fail to address other systemic barriers to health care. Insurance alone will not solve the health problems faced by children and adolescents. SPECIAL NEEDS OF CHILDREN AND ADOLESCENTS Addressing the health risks that children and adolescents face requires combining public and private efforts and community-oriented and personal care services.

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Abbas, Kaja M., Gloria J. Kang, Daniel Chen, Stephen R. Werre et Achla Marathe. « Demographics, perceptions, and socioeconomic factors affecting influenza vaccination among adults in the United States ». PeerJ 6 (13 juillet 2018) : e5171. http://dx.doi.org/10.7717/peerj.5171.

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Objective The study objective is to analyze influenza vaccination status by demographic factors, perceived vaccine efficacy, social influence, herd immunity, vaccine cost, health insurance status, and barriers to influenza vaccination among adults 18 years and older in the United States. Background Influenza vaccination coverage among adults 18 years and older was 41% during 2010–2011 and has increased and plateaued at 43% during 2016–2017. This is below the target of 70% influenza vaccination coverage among adults, which is an objective of the Healthy People 2020 initiative. Methods We conducted a survey of a nationally representative sample of adults 18 years and older in the United States on factors affecting influenza vaccination. We conducted bivariate analysis using Rao-Scott chi-square test and multivariate analysis using weighted multinomial logistic regression of this survey data to determine the effect of demographics, perceived vaccine efficacy, social influence, herd immunity, vaccine cost, health insurance, and barriers associated with influenza vaccination uptake among adults in the United States. Results Influenza vaccination rates are relatively high among adults in older age groups (73.3% among 75 + year old), adults with education levels of bachelor’s degree or higher (45.1%), non-Hispanic Whites (41.8%), adults with higher incomes (52.8% among adults with income of over $150,000), partnered adults (43.2%), non-working adults (46.2%), and adults with internet access (39.9%). Influenza vaccine is taken every year by 76% of adults who perceive that the vaccine is very effective, 64.2% of adults who are socially influenced by others, and 41.8% of adults with health insurance, while 72.3% of adults without health insurance never get vaccinated. Facilitators for adults getting vaccinated every year in comparison to only some years include older age, perception of high vaccine effectiveness, higher income and no out-of-pocket payments. Barriers for adults never getting vaccinated in comparison to only some years include lack of health insurance, disliking of shots, perception of low vaccine effectiveness, low perception of risk for influenza infection, and perception of risky side effects. Conclusion Influenza vaccination rates among adults in the United States can be improved towards the Healthy People 2020 target of 70% by increasing awareness of the safety, efficacy and need for influenza vaccination, leveraging the practices and principles of commercial and social marketing to improve vaccine trust, confidence and acceptance, and lowering out-of-pocket expenses and covering influenza vaccination costs through health insurance.

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Kumar, Santosh, et Roopali Sharma. « Key barriers in the growth of rural health care : an ISM-MICMAC approach ». Benchmarking : An International Journal 25, n^o 7 (1 octobre 2018) : 2169–83. http://dx.doi.org/10.1108/bij-05-2017-0095.

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Purpose The health care industry has experienced vibrant growth since the last few decades. Total health care business has reached more than US$160bn in the country and is still growing, but sustainable growth of industry is a major area of concern. An unsustainable and uneven growth might contribute in growth presently, but will not help in the long run due to extinction in future. The paper aims to discuss this issue. Design/methodology/approach The research has been divided into two phases to analyze the barriers to achieve sustainable growth, i.e., identification of barriers and their analysis. The study has used three different research phases: identification of barriers from the literature, interviews with experts of industry and designing an ISM model. The identification phase led to the selection of 19 barriers from literature and by suggestions from industrial experts. The interpretive structural modeling (ISM) analysis was used to understand the impact and linkage of identified barriers. The barriers are further classified into four major categories on the basis of drive power and dependence power using “Matrices d’Impacts Croises Multiplication. Appliqué a un Classement” analysis. Findings The present research identifies 19 barriers in the field of growth of health care mainly in rural area with 11 levels in ISM-designed model. Barriers such as lack of awareness, medical mistrust, cost/benefit, transportation, high out of pocket expenditure, lack of health insurance, medical unawareness and the cultural dimension (traditional beliefs) have very high dependency power. These variables are highly influenced by other barriers. Barriers such as low outreach (geographical reach), information and communication, insufficient capacity planning, and highest growth in population have very high driving and dependence power. They have a very high impact on the system as any change in them will have a direct impact on others. Remaining seven selected barriers have a very high driving power and they are generally independent in nature and have less impact on the system as whole. Social implications This study seeks to identify which barrier is acting as the most dominant one and this result is helpful for policy-makers to achieve goals of National Health Mission (NHM) by removing the dominant barrier. Originality/value Total health care business reaches more than US$160bn in the country and is still growing, but sustainable growth of industry is a major area of concern. This paper is one of the preliminary attempts to identify which barrier is acting as the most dominant one and this result is helpful for policy-makers to achieve the goals of NHM by removing the dominant barrier.

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Fryling, Lauren R., Peter Mazanec et Robert M. Rodriguez. « Barriers to Homeless Persons Acquiring Health Insurance Through the Affordable Care Act ». Journal of Emergency Medicine 49, n^o 5 (novembre 2015) : 755–62. http://dx.doi.org/10.1016/j.jemermed.2015.06.005.

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Seidu, Abdul-Aziz. « Mixed effects analysis of factors associated with barriers to accessing healthcare among women in sub-Saharan Africa : Insights from demographic and health surveys ». PLOS ONE 15, n^o 11 (9 novembre 2020) : e0241409. http://dx.doi.org/10.1371/journal.pone.0241409.

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Background Access to healthcare is one of the key global concerns as treasured in the Sustainable Development Goals. This study, therefore, sought to assess the individual and contextual factors associated with barriers to accessing healthcare among women in sub-Saharan Africa (SSA). Materials and methods Data for this study were obtained from the latest Demographic and Health Surveys (DHS) conducted between January 2010 and December 2018 across 24 countries in SSA. The sample comprised 307,611 women aged 15–49. Data were analysed with STATA version 14.2 using both descriptive and multilevel logistic regression modelling. Statistical significance was set at p<0.05. Results It was found that 61.5% of women in SSA face barriers in accessing healthcare. The predominant barriers were getting money needed for treatment (50.1%) and distance to health facility (37.3%). Women aged 35–39 (AOR = 0.945, CI: 0.911–0.980), married women (AOR = 0.694, CI: 0.658–0.732), richest women (AOR = 0.457, CI:0.443–0.472), and those who read newspaper or magazine at least once a week (AOR = 0.893, CI:0.811–0.983) had lower odds of facing barriers in accessing healthcare. However, those with no formal education (AOR = 1.803, CI:1.718–1.891), those in manual occupations (AOR = 1.551, CI: 1.424–1.689), those with parity 4 or more (AOR = 1.211, CI: 1.169–1.255), those who were not covered by health insurance (AOR = 1.284, CI: 1.248–1.322), and those in rural areas (AOR = 1.235, CI:1.209–1.26) had higher odds of facing barriers to healthcare access. Conclusion Both individual and contextual factors are associated with barriers to healthcare accessibility in SSA. Particularly, age, marital status, employment, parity, health insurance coverage, exposure to mass media, wealth status and place of residence are associated with barriers to healthcare accessibility. These factors ought to be considered at the various countries in SSA to strengthen existing strategies and develop new interventions to help mitigate the barriers. Some of the SSA African countries can adopt successful programs in other parts of SSA to suit their context such as the National Health Insurance Scheme (NHIS) and the Community-based Health Planning and Services concepts in Ghana.

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Larimer, Karen A., Meg Gulanick et Sue Penckofer. « Understanding Determinants of Cardiovascular Health in a Mexican American Community ». Health Promotion Practice 18, n^o 4 (24 mars 2017) : 534–44. http://dx.doi.org/10.1177/1524839917698095.

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Cardiovascular disease (CVD) is the leading cause of death in Hispanic Americans. Social and physical determinants of health unique to this community must be understood before interventions can be designed and implemented. This article describes a CVD risk assessment conducted in a primarily Mexican American community, using Healthy People 2020 as a model. Social (language, culture, awareness of CVD, and socio-economic status) and physical (presence and use of recreation areas, presence of grocery stores, public transportation, and environmental pollution) determinants of health as well as access to health services were assessed. Fifteen community leaders were interviewed using guided interviews. Database searches and direct observations were conducted. Using these methods provided comprehensive assessment of social and physical determinants of health, and access issues that were unique to the community studied. Findings demonstrated greater awareness of diabetes than CVD as a health problem, with little knowledge of CVD risk factors. Lack of access to health services (lack of insurance, lack of a medical home) and presence of cultural and socioeconomic barriers such as language, unemployment, low income, and lack of insurance were identified. The physical determinants such as environment presented fewer barriers, with adequate access to fruits and vegetables, transportation, and parks. Results revealed target areas for intervention.

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Gaborcik, Joshua W., Brigid K. Groves, Aaron Clark, Marilly Palettas et Alexa Sevin Valentino. « An Ambulatory Care Clinic and Community Pharmacy Collaboration to Address Prescription Abandonment ». INNOVATIONS in pharmacy 10, n^o 1 (8 mars 2019) : 14. http://dx.doi.org/10.24926/iip.v10i1.1540.

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Purpose: The purpose of this research is to evaluate a collaborative workflow aimed at decreasing prescription abandonment. Setting: A federally qualified health center and a 340B contracted grocery store-based community pharmacy. Practice Workflow: An ambulatory care clinic with an established partnership with a community pharmacy chain identified a need to decrease prescription abandonment rates. A process was developed whereby an ambulatory care pharmacy technician received a report from the pharmacy of prescriptions filled for at least 7 days since the initial fill date and at risk for abandonment at the community pharmacy. The pharmacy technician identified health-system barriers, attempted to remedy any identified barriers, and conducted patient reminder phone calls. Health-system barriers were classified by the following categories: incorrect contact information at the community pharmacy, incorrect 340B copayment, incorrect insurance information at the community pharmacy, and need for prior authorization. Evaluation: A prospective cohort study was conducted from February 2016 to April 2016 in order to evaluate the effectiveness of this workflow. Results: 551 prescriptions and 350 patients were included in this cohort. Of the 551 prescriptions, 362 had at least one identified barrier that may have led to prescription abandonment. There were 111 health-system identified barriers, and 96 of these barriers were acted upon. Additionally, there were 459 patient identified barriers, and 179 of these barriers were acted upon. When a pharmacy technician was able to identify and act upon at least one barrier, 106 prescriptions (46.9%) were picked-up from the pharmacy. Conclusion: From the information gathered in this quality improvement project, operational changes have been implemented at the ambulatory care clinic and community pharmacy as a means to further decrease modifiable health-system barriers that may lead to prescription abandonment. Article Type: Clinical Experience

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Joarder, Taufique, Tahrim Z. Chaudhury et Ishtiaq Mannan. « Universal Health Coverage in Bangladesh : Activities, Challenges, and Suggestions ». Advances in Public Health 2019 (3 mars 2019) : 1–12. http://dx.doi.org/10.1155/2019/4954095.

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Catastrophic health expenditure forces 5.7 million Bangladeshis into poverty. Inequity is present in most of health indicators across social, economic, and demographic parameters. This study explores the existing health policy environment and current activities to further the progress towards Universal Health Coverage (UHC) and the challenges faced in these endeavors. This qualitative study involved document reviews (n=22) and key informant interviews (KII, n=15). Thematic analysis of texts (themes: activities around UHC, implementation barriers, suggestions) was done using the manual coding technique. We found that Bangladesh has a comprehensive set of policies for UHC, e.g., a health-financing strategy and staged recommendations for pooling of funds to create a national health insurance scheme and expand financial protection for health. Progress has been made in a number of areas including the roll out of the essential package of health services for all, expansion of access to primary health care services (support by donors), and the piloting of health insurance which has been piloted in three subdistricts. Political commitment for these areas is strong. However, there are barriers pertaining to the larger policy level which includes a rigid public financing structure dating from the colonial era. While others pertain to the health sector’s implementation shortfalls including issues of human resources, political interference, monitoring, and supervision, most key informants discussed demand-side barriers too, such as sociocultural disinclination, historical mistrust, and lack of empowerment. To overcome these, several policies have been recommended, e.g., redesigning the public finance structure, improving governance and regulatory mechanism, specifying code of conduct for service providers, introducing health-financing reform, and collaborating with different sectors. To address the implementation barriers, recommendations include improving service quality, strengthening overall health systems, improving health service management, and improving monitoring and supervision. Addressing demand-side barriers, such as patient education and community empowerment, is also needed. Research and advocacy are required to address crosscutting barriers such as the lack of common understanding of UHC.

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DeVoe, J. E., A. Baez, H. Angier, L. Krois, C. Edlund et P. A. Carney. « Insurance + Access != Health Care : Typology of Barriers to Health Care Access for Low-Income Families ». Annals of Family Medicine 5, n^o 6 (1 novembre 2007) : 511–18. http://dx.doi.org/10.1370/afm.748.

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