Access To Health Insurance Research Articles

SELF-EMPLOYMENT AMONG OLDER HISPANICS: INTRAGROUP DIVERSITY, WORKPLACE BENEFITS, AND CITIZENSHIP STATUS

Abstract Hispanics play a significant role in the self-employment landscape among older workers, yet research on this subject often ignores intragroup heterogeneity. Investigating these intragroup differences may highlight differential access to safety-net programs (e.g., health insurance, retirement savings programs) and economic opportunities (e.g., business incorporation). In response, this study utilized data from the Current Population Survey Annual Social and Economic Supplement, obtained from IPUMS-CPS, to assess differences in incorporated (I-SE) and unincorporated (U-SE) self-employment rates among those 50 to 64 years old by seven Hispanic subgroups within the U.S. (Mexican, Puerto Rican, Cuban, Dominican, Salvadoran, Central and South American, and Other Hispanic). Using pooled data between 2017 and 2022 to reduce sampling noise, we estimated health insurance access, retirement savings program access, and citizenship status by subgroup and incorporation status. We found notable differences by subgroup in overall self-employment rates (e.g., Cubans had the highest rates: 5% I-SE, 6% U-SE%; Puerto Ricans had the lowest rates: 2% I-SE, 2% U-SE). Salvadorans had the lowest health insurance coverage rates (48% I-SE, 58% U-SE). Those falling within the “Other Hispanic” category, including Spaniards, participated the most in workplace retirement savings programs (26% I-SE, 7% U-SE). Excluding Puerto Ricans, who are U.S. citizens, Dominicans in unincorporated self-employment (46% citizens) and Salvadorans in incorporated self-employment (41% citizens) were the least likely to hold citizenship status. These findings identify important gaps in access to health insurance and retirement savings programs, as well as more lucrative incorporated self-employment opportunities, by subgroup.

Facilitators of medication adherence in patients with hypertension: a qualitative study.

Hypertension has been identified as the most important risk factor for disability and premature death worldwide. This study aimed to explain the factors that facilitate medication adherence from the perspective of patients with hypertension in southeastern Iran. This qualitative study used conventional content analysis and purposive sampling methods to achieve data saturation, involving 25 participants. Facilitating factors were categorized into two main categories: individual and family factors and organizational support. Individual factors included motivational fears, disease acceptance, healthy lifestyle, disease monitoring, and follow-up. Family factors included family support, while organizational support included governmental support to provide inexpensive medicines, comprehensive healthcare team support, health insurance access, and media training. These factors were identified as essential facilitators that significantly influence appropriate adherence to hypertensive drugs. This study revealed that various factors affected medication adherence in these patients, and efforts should be made to improve hypertension treatment and increase medication adherence. Measures taken to control hypertension are cost-effective to reduce the burden associated with this disease. The findings of this study can be valuable in formulating policies for the treatment and care of hypertension.

Prevalence of Cardiovascular-Kidney-Metabolic Syndrome Stages by Social Determinants of Health

Cardiovascular-kidney-metabolic (CKM) syndrome-a novel, multistage, multisystem disorder as defined by the American Heart Association-is highly prevalent in the US. However, the prevalence of CKM stages by social determinants of health (SDOH) remains unclear. To investigate whether the prevalence of CKM stages varies by SDOH in US adults. This cross-sectional study used data from the National Health and Nutrition Examination Survey (1999-2018) and included a nationally representative sample of adults aged 30 to 79 years through complex, multistage probability sampling. Data were analyzed from April 1 to June 15, 2024. The exposures included 5 CKM stages (ie, stages 0-4) reflecting progressive pathophysiology, with advanced (stages 3 or 4) and nonadvanced (stages 0, 1, or 2) disease. CKM stages were defined based on risk factors for metabolic syndrome, cardiovascular disease, and chronic kidney disease. The main outcome was the age-standardized prevalence of CKM stages and advanced CKM stages across SDOH, including education, marital status, family income, food security, health insurance, employment, home ownership, and health care access. Among 29 722 participants (weighted mean [SE] age, 50.8 [0.1] years; weighted 50.7% male), the age-standardized prevalence of CKM stages 0 to 4 was 13.6% (95% CI, 13.0%-14.3%), 29.9% (95% CI, 29.1%-30.7%), 43.7% (95% CI, 42.9%-44.5%), 4.7% (95% CI, 4.4%-5.0%), and 8.1% (95% CI, 7.6%-8.5%), respectively. Significant differences were observed in the prevalence of CKM stages across all unfavorable SDOH of interest compared with their favorable counterparts, with unemployment (18.8% [95% CI, 17.7%-20.1%] vs 11.4% [95% CI, 11.0%-11.9%]), low family income (16.1% [95% CI, 15.4%-16.8%] vs 10.1% [95% CI, 9.5%-10.7%]), and food insecurity (18.3% [95% CI, 17.1%-19.6%] vs 11.7% [95% CI, 11.2%-12.2%]) associated with an increased likelihood of advanced CKM stages. Participants with 2 or more unfavorable SDOH were more likely to have advanced CKM stages (age-standardized prevalence, 15.8% [95% CI, 15.2%-16.5%] vs 10.5% [95% CI, 9.9%-11.1%] with <2 unfavorable SDOH). Living in a rented home (15.9% [95% CI, 14.7%-17.0%] vs 9.3% [95% CI, 8.7%-9.9%] owning the home) or not living with a partner (13.2% [95% CI, 12.3%-14.3%] vs 9.2% [95% CI, 8.5%-9.8%] living with a partner) increased the likelihood of advanced CKM stages in female but not male participants. In this cross-sectional study, disparities in the prevalence of CKM stages by SDOH, particularly family income, food security, and employment, with notable sex differences, were observed in US adults. These findings highlight the need to address inequities in CKM syndrome through targeted interventions.

Association Between Social Determinants of Health and Patient Portal Utilization in the United States

(1) Background: Differences in health outcomes across populations are due to disparities in access to the social determinants of health (SDoH), such as educational level, household income, and internet access. With several positive outcomes reported with patient portal use, examining the associated social determinants of health is imperative. Objective: This study analyzed the association between social determinants of health—education, health insurance, household income, rurality, and internet access—and patient portal use among adults in the United States before and after the COVID-19 pandemic. (2) Methods: The research used a quantitative, retrospective study design and secondary data from the combined cycles 1 to 4 of the Health Information National Trends Survey 5 (N = 14,103) and 6 (N = 5958). Descriptive statistics and logistic regression were conducted to examine the association between the variables operationalizing SDoH and the use of patient portals. (3) Results: Forty-percent (40%) of respondents reported using a patient portal before the pandemic, and this increased to 61% in 2022. The multivariable logistic regression showed higher odds of patient portal utilization by women compared to men (AOR = 1.56; CI, 1.32–1.83), those with at least a college degree compared to less than high school education (AOR = 2.23; CI, 1.29–3.83), and annual family income of USD 75,000 and above compared to those &lt;USD 20,000 (AOR = 1.59; CI, 1.18–2.15). Those with access to the internet and health insurance also had significantly higher odds of using their patient portals. However, those who identified as Hispanic and non-Hispanic Black and residing in a rural area rather than urban (AOR = 0.72; CI, 0.54–0.95) had significantly lower odds of using their patient portals even after the pandemic. (4) Conclusions: The social determinants of health included in this study showed significant influence on patient portal utilization, which has implications for policymakers and public health stakeholders tasked with promoting patient portal utilization and its benefits.

Abstract 4134272: Association of depression symptoms with cardiovascular health stratified by military status: Insights from 2013-2020 National Health and Nutrition Examination Survey

Introduction: Emerging evidence supports the mind-heart-body connection, yet less attention has been given to examining the relationship in specific populations. Veterans have a higher risk for mental and cardiovascular problems and have unique social determinants of health (SDoH), such as healthcare access, than civilians. This study aims to examine how depression and SDoH are associated with cardiovascular health (CVH) and if associations differ by military status. Hypotheses: 1) Depression symptoms and SDoH will be associated with CVH. 2) The associations will differ between people who served in the US military and those who did not. Methods: A cross-sectional analysis was conducted using data from the 2013 to 2020 National Health and Nutrition Examination Survey. Individuals were aged ≥ 20 years without cardiovascular disease and current pregnancy. Patient Health Questionnaire-9 was used to assess depression symptoms and dichotomized into no symptoms (&lt;5) and mild-to-severe symptoms (≥5). The Life's Essential 8 quantified CVH, with scores from 0-100. SDoH included age, gender, race/ethnicity, marital status, education, employment, financial status, health insurance, and healthcare access. Sample weights were applied in multiple linear regression analyses. Results: Among 6498 participants, 92% were civilians (mean age: 45 years; 51% female), and 8% were veterans (mean age: 56 years; 10% female). In both groups, 23% had depression symptoms. The mean CVH was 72 in civilians and 69 in veterans. In adjusted models, individuals with depression symptoms had 4 points lower CVH scores than those without (95% CI: -5.11, -2.84). This trend was similar in civilians but insignificant in veterans. Lower CVH was significantly associated with age, being non-Hispanic Black and other races people, lower education, and lower financial status. The associations were preserved after being stratified by military status. Conclusions: Depression symptoms and SDoH were associated with lower CVH. However, there was no significant evidence that military status moderated the associations of depression and SDoH with CVH. Examining the intersection between depressive symptoms and SDoH may be useful when assessing CVH.

The out-of-pocket cost of breast cancer care in Nigeria: A prospective analysis

Most patients pay out-of-pocket for cancer care in Nigeria, which can result in a catastrophic health care expenditure (CHE). There is a paucity of economic data on the cost of care and the impact this may have on the household. This study provides a prospective analysis of direct and indirect out-of-pocket costs for breast cancer care at a single tertiary care institution in South West Nigeria. Consecutive patients undergoing curative intent treatment for a new diagnosis of breast cancer between August 2019 and September 2022 were approached for enrollment. A novel questionnaire was delivered to patients during hospital admission and again during six-month follow-up. Patients self-reported annual household income, capacity-to-pay, and all direct and indirect expenditures associated with access care. A CHE was defined using three commonly used definitions, including total healthcare expenditure that exceeds 40 % of a household's capacity-to-pay, or exceeds the proportion of annual income set at thresholds of 10 % and 25 %. Data were collected from 71 eligible patients with a mean age of 49.5 years (SD 11.26). Sixty-six percent (47/71, 66.2 %) of patients had ≥ Stage III disease at presentation, and 95.8 % received systemic chemotherapy. Only 23.9 % received adjuvant radiotherapy. The mean annual capacity-to-pay for the cohort was $2866.93 (SD $2749.74). The mean cost of care was $5192.77 (SD $4567.71). Out of the 71 patients enrolled in the study, between 56 (78.9 %) and 71 (100 %) experienced a CHE, depending on the included costs (direct +/- indirect) and threshold used. Sixty-six percent of patients had no form of health insurance. Over 70 % of breast cancer patients at a tertiary care facility in Nigeria experience a CHE because of out-of-pocket costs associated with accessing care. A more effective and accessible health insurance mechanism is required in Nigeria to protect women with breast cancer from the cost of cancer care.

Lung Cancer Screening Health Belief Model: Psychometric Properties of the Arabic Version and Factors Influencing Screening and Prevention Among Jordanians.

Several screening models have recently been applied to study awareness and help people make informed decisions regarding cancer screening. This study aimed to explore the knowledge, attitudes, and lung cancer screening health beliefs (LCSHBs) among Jordanians. Moreover, we intended to translate the LCSHBs scale into the Arabic language and test its validity and reliability. An online survey (Google Forms) was completed by 916 participants in Jordan via snowball sampling technique from February 10, 2024, to March 2, 2024, assessing lung cancer screening knowledge, lung cancer preventive attitudes, screening-related health beliefs, and stages of screening adoption. Linear regression analysis, correlations, and non-parametric statistics were utilized for statistical inference. Participants had high mean percentage scores of 86.56% and 85.75% for knowledge and preventive attitudes towards lung cancer screening, respectively. The Arabic version of the LCSHBs model was found to be a valid and reliable tool, as indicated by principal component analysis extraction and Cronbach's alpha values. Lung cancer screening knowledge was positively associated with perceived benefits and negatively associated with perceived barriers to screening. Knowledge, perceived barriers, perceived risk of lung cancer, self-efficacy (SE) to screen, and lung cancer preventive attitudes were significantly associated with the perceived benefits of lung cancer screening (p<0.05). We also found that the higher the SE, the higher the physical activity and the lower the perceived barriers. The Arabic version of the LCSHBs model is valid and reliable for assessing health beliefs toward lung cancer screening. We recommend enhancing targeted interventions, educational outreach, and improving health insurance access to reduce lung cancer incidence in Jordan and promote screening behaviors.

Toward Universal Health Coverage: What Socioeconomic and Clinical Factors Influence Health Insurance Coverage and Restrictions in Access to Viral Hepatitis Services in Nasarawa State, Nigeria?

Background: Viral hepatitis B and C (HBV and HCV) pose significant public health concern in Nigeria, where access to healthcare and treatment affordability are limited. This study investigated sociodemographic and clinical predictors of health insurance coverage and access to care among patients with HBV and HCV in Nasarawa State, Nigeria. Methods: A cross-sectional facility-based study was conducted at two secondary hospitals in Nasarawa State, Nigeria. Participants included patients diagnosed with HBV, HCV, or both who were ≥18 years old. Data were collected using a structured questionnaire covering sociodemographic and clinical information, health insurance details, and economic impact. Binary logistic regression was used to analyze the relationship between sociodemographic/clinical factors and health insurance status. Results: Out of 303 participants, 68% had health insurance, which mostly covered hepatitis screening and vaccination. Significant predictors of health insurance coverage included being aged 36-40 years (adjusted odds ratio [aOR]: 11.01, 95% confidence interval [CI]: 2.38-50.89, p = 0.002), having post-secondary education (aOR: 25.2, 95% CI: 9.67-65.68, p < 0.001), being employed (aOR: 27.83, 95% CI: 8.85-87.58, p < 0.001), and being HIV-positive (aOR: 4.06, 95% CI: 1.55-10.61, p = 0.004). Nearly all those insured (99%) faced restrictions in insurance coverage for viral hepatitis services. Conclusions: This study reveals that while health insurance coverage is relatively high among viral hepatitis patients in Nasarawa State, significant restrictions hinder access to comprehensive services, especially for vulnerable groups like younger adults, the unemployed, and PLHIV. Key factors influencing coverage include age, education, employment, and HIV status. Expanding benefit packages to include viral hepatitis diagnosis and treatment, raising awareness about viral hepatitis as part of insurance strategy, improving access for underserved populations, and integrating hepatitis services into existing HIV programs with strong policy implementation monitoring frameworks are crucial to advancing universal health coverage and meeting the WHO's 2030 elimination goals.

Health Insurance Type and Access to the Indian Health Service Before, During, and After Childbirth Among American Indian and Alaska Native People in the United States

American Indian and Alaska Native (AI/AN) people in the United States face elevated childbirth-related risks when compared with non-Hispanic white people. Access to health care is a treaty right of many AI/AN people, often facilitated through the Indian Health Service (IHS), but many AI/AN people do not qualify for or cannot access IHS care and rely on health insurance coverage to access care in other facilities. Our goal was to describe health insurance coverage and access to IHS care before, during, and after childbirth for AI/AN birthing people in the United States. We analyzed 2016 to 2020 Pregnancy Risk Assessment Monitoring System data (44 states and two other jurisdictions) for 102,860 postpartum individuals (12,920 AI/AN and 89,940 non-Hispanic white). We calculated weighted percentages, adjusted predicted probabilities, and percentage point differences for health care coverage (insurance type and IHS care) before, during, and after childbirth. Approximately 75% of AI/AN birthing people did not have IHS care around the time of childbirth. AI/AN people had greater variability in insurance coverage and more insurance churn (changes in type of insurance, including between coverage and no coverage) during the perinatal period, compared with non-Hispanic white people. Health care coverage differed for rural and urban AI/AN people, with rural AI/AN residents having the lowest prevalence of continuous insurance (60%). AI/AN birthing people experience insurance churning and limited access to IHS care during the perinatal period. Efforts to improve care for AI/AN birthing people should engage federal, state, and tribal entities to ensure fulfillment of the trust responsibility of the United States and to address health inequities.

Supply-side factors influencing national health insurance uptake, access and use of primary health care: Evidence from the Upper West Region, Ghana

Supply-side factors influencing national health insurance uptake, access and use of primary health care: Evidence from the Upper West Region, Ghana

Should Patients Be Allowed to Pay Out of Pocket? The Ethical Dilemma of Access to Expensive Anti-cancer Treatments in Universal Healthcare Systems: A Dutch Case Study.

With the increasing prices of newly approved anti-cancer treatments contributing to rising healthcare costs, healthcare systems are facing complex economic and ethical dilemmas. Especially in countries with universal access and mandatory health insurance, including many European countries, the organizing of funding or reimbursement of expensive new treatments can be challenging. When expensive anti-cancer treatments are deemed safe and effective, but are not (yet) reimbursed, ethical dilemmas arise. In countries with universal healthcare systems, such as the Netherlands, this gives rise to a rather new ethical dilemma: should patients be allowed to pay out of pocket, using private funds, for medical treatments? On the one hand, to allow patients to pay for treatments out of pocket would be in line with the medical-ethical principles of beneficence and autonomy. On the other hand, allowing patients to pay out of pocket for anti-cancer treatments may lead to unequal access to medical treatments and could be considered unfair to patients who are less well-off. Thus, it could undermine the values of equality and solidarity, on which the Dutch healthcare system is built. Furthermore, out-of-pocket payments could potentially lead to financial hardship and distress for patients, which would conflict with the principle of non-maleficence. Does this mean that patients can rightfully be denied access to approved but not (yet) reimbursed anti-cancer treatments? In this article, we will use the Dutch healthcare system, which is based on equal access and solidarity, as a case study to draw attention to this-currently relatively unknown and unresolved-dilemma and to clarify the values at stake. This article contributes to current discussions about the societal problem of rising healthcare costs by informing policymakers, healthcare professionals, and ethicists about the ethical dilemma of out-of-pocket payments in universal healthcare systems, and aims to support health authorities, policymakers and health professionals in developing policy for whether to allow out-of-pocket payment-based access to newly approved but (too) expensive anti-cancer treatments.

Health Insurance Factor Analysis

This paper explores the intricacies of health insurance costs in the United States, emphasizing the Affordable Care Act's (ACA) role in reform. Employing a "health insurance factor analysis" approach, the study identifies key determinants using data visualization and regression models. Factors such as age, BMI, family size, gender, smoking status, and geographic region significantly influence insurance prices. The research evaluates various regression models and neural networks, with linear regression standing out for its high accuracy. The findings underscore the impact of smoking, medical history, and coverage level on insurance costs. Despite dataset limitations and sample size considerations, this study contributes to a nuanced understanding of health insurance pricing, aiding insurers, policymakers, and individuals in decision-making. By integrating data insights and predictive models, the research advances comprehension of the complex relationships shaping health insurance costs. The ultimate goal is to optimize insurance programs and promote accessible and affordable health insurance for all.

Access to Care and Outcomes With the Affordable Care Act for Persons With Criminal Legal Involvement

By expanding health insurance to millions of people in the US, the Patient Protection and Affordable Care Act (ACA) may have important health, economic, and social welfare implications for people with criminal legal involvement-a population with disproportionately high morbidity and mortality rates. To scope the literature for studies assessing the association of any provision of the ACA with 5 types of outcomes, including insurance coverage rates, access to care, health outcomes, costs of care, and social welfare outcomes among people with criminal legal involvement. The literature search included results from PubMed, CINAHL Complete, APA Psycinfo, Embase, Social Science Database, and Web of Science and was conducted to include articles from January 1, 2014, through December 31, 2023. Only original empirical studies were included, but there were no restrictions on study design. Of the 3538 studies initially identified for potential inclusion, the final sample included 19 studies. These 19 studies differed substantially in their definition of criminal legal involvement and units of analysis. The studies also varied with respect to study design, but difference-in-differences methods were used in 10 of the included studies. With respect to outcomes, 100 unique outcomes were identified across the 19 studies, with at least 1 in all 5 outcome categories determined prior to the literature search. Health insurance coverage and access to care were the most frequently studied outcomes. Results for the other 3 outcome categories were mixed, potentially due to heterogeneous definitions of populations, interventions, and outcomes and to limitations in the availability of individual-level datasets that link incarceration data with health-related data. In this scoping review, the ACA was associated with an increase in insurance coverage and a decrease in recidivism rates among people with criminal legal involvement. Future research and data collection are needed to understand more fully health and nonhealth outcomes among people with criminal legal involvement related to the ACA and other health insurance policies-as well as the mechanisms underlying these relationships.

An exploratory analysis of the impact of area-level exposome on geographic disparities in aggressive prostate cancer

Numbers of aggressive prostate cancer (aPC) cases are rising, but only a few risk factors have been identified. In this study, we introduce a systematic approach to integrate geospatial data into external exposome research using aPC cases from Pennsylvania. We demonstrate the association between several area-level exposome measures across five Social Determinants of Health domains (SDOH) and geographic areas identified as having elevated odds of aPC. Residential locations of Pennsylvania men diagnosed with aPC from 2005 to 2017 were linked to 37 county-/tract-level SDOH exosome measures. Variable reduction processes adopted from neighborhood-wide association study along with Bayesian geoadditive logistic regression were used to identify areas with elevated odds of aPC and exposome factors that significantly attenuated the odds and reduced the size of identified areas. Areas with significantly higher odds of aPC were explained by various SDOH exposome measures, though the extent of the reduction depended on geographic location. Some areas were associated with race (social context), health insurance (access), or tract-level poverty (economics), while others were associated with either county-level water quality or a combination of factors. Area-level exposome measures can guide future patient-level external exposome research and help design targeted interventions to reduce local cancer burden.

Forecasting the National Health Insurance Fund Membership Enrolment in Tanzania Using the SARIMA Model

This paper aimed at forecasting membership enrolment in the National Health Insurance Fund (NHIF) in Tanzania using quarterly time series data. This study used 88 time series data to fit the seasonal Autoregressive Integrated Moving Average model (SARIMA). ARIMA (3,1,1) (0,1,0)[4] model was built and used for forecasting. The results show that there will be an increasing membership enrolment overtime over the years and no signs of decreasing. Thus, the government, apart from continuing subsidizing the cost of accessing health insurance services, should also improve the National Health Insurance (NHI) coverage to accommodate the increased enrolment and discourage dropouts. In turn, this will help to achieve the Universal Health Coverage (UHC) ultimate aim of ensuring equitable access to essential and manageable healthcare services, regardless of individuals’ financial situations, their location, and personality.

Medicare Eligibility and Changes in Coverage, Access to Care, and Health by Sexual Orientation and Gender Identity

Medicare provides nearly universal insurance coverage at age 65 years. However, how Medicare eligibility affects disparities in health insurance coverage, access to care, and health status among individuals by sexual orientation and gender identity is poorly understood. To assess the association of Medicare eligibility with disparities in health insurance coverage, access to care, and self-reported health status among individuals by sexual orientation and by gender identity. This cross-sectional study used the age discontinuity for Medicare eligibility at age 65 years to isolate the association of Medicare with health insurance coverage, access to care, and self-reported health status, by their sexual orientation and by their gender identity. Data were collected from the Behavioral Risk Factor Surveillance System for respondents from 51 to 79 years old from 2014 to 2021. Data analysis was performed from September 2022 to April 2023. Medicare eligibility at age 65 years. Proportions of respondents with health insurance coverage, usual source of care, cost barriers to care, influenza vaccination, and self-reported health status. The study population included 927 952 individuals (mean [SD] age, 64.4 [7.7] years; 524 972 [56.6%] females and 402 670 [43.4%] males), of whom 28 077 (3.03%) identified as a sexual minority-lesbian, gay, bisexual, or another sexual minority identity (LGB+) and 3286 (0.35%) as transgender or gender diverse. Respondents who identified as heterosexual had greater improvements at age 65 years in insurance coverage (4.2 percentage points [pp]; 95% CI, 4.0-4.4 pp) than those who identified as LGB+ (3.6 pp; 95% CI, 2.3-4.8 pp), except when the analysis was limited to a subsample of married respondents. For access to care, improvements in usual source of care, cost barriers to care, and influenza vaccination were larger at age 65 years for heterosexual respondents compared with LGB+ respondents, although confidence intervals were overlapping and less precise for LGB+ individuals. For self-reported health status, the analyses found larger improvements at age 65 years for LGB+ respondents compared with heterosexual respondents. There was considerable heterogeneity by state in disparities by sexual orientation among individuals who were nearly eligible for Medicare (close to 65 years old), with the US South and Central states demonstrating the highest disparities. Among the top-10 highest-disparities states, Medicare eligibility was associated with greater increases in coverage (6.7 pp vs 5.0 pp) and access to a usual source of care (1.4 pp vs 0.6 pp) for LGB+ respondents compared with heterosexual respondents. The findings of this cross-sectional study indicate that Medicare eligibility was not associated with consistently greater improvements in health insurance coverage and access to care among LGBTQI+ individuals compared with heterosexual and/or cisgender individuals. However, among sexual minority individuals, Medicare may be associated with closing gaps in self-reported health status, and among states with the highest disparities, it may improve health insurance coverage, access to care, and self-reported health status.

Race, partisanship, and the distinctiveness of vaccine hesitancy in health care attitudes

ABSTRACT Partisanship has served a dominant role in influencing public opinion on health reform in the United States in the past decade. Republicans are significantly less supportive than Democrats of expanding the Affordable Care Act and implementing broader government insurance provisions. With the onset of the pandemic, partisan divisions have also spilled over into polarized attitudes on public health measures to curb the spread of COVID-19 and vaccine uptake. The influence of partisanship should not be overstated, however, particularly when examining public opinion across racial groups. Black Americans were among the strongest proponents of health reform during the passage of the Affordable Care Act, and they remained strong supporters of Democratic-led proposals to expand health insurance access and of many public health measures to curb the spread of COVID-19. But high levels of Democratic partisanship alone cannot explain the dynamics of Black public opinion on vaccination, an issue for which Black Democrats consistently show more skepticism than white Democrats. Using multiple sources of nationally representative survey data from 2016 to 2022, this study illustrates how self-interest and racialized experiences with the government and the health care system help explain the distinctive racial divide in vaccination attitudes.

Association of the US Affordable Care Act-Dependent Coverage Provision With Labor Neuraxial Analgesia Use

(Anesthesiology. 2023;139:274–286) Neuraxial analgesia during labor is both safe and effective and has been associated with a lower risk of severe maternal morbidity. However, utilization is lower in minority groups, who experience a higher risk of severe maternal morbidity. Therefore, it is imperative to increase utilization and access, especially among minority ethnic and racial groups. This study examined the factor of health insurance access, specifically the effect of the Dependent Coverage Provision for the Patient Protection and Affordable Care Act on the use of neuraxial analgesia during labor, both in women from minority groups and overall.

Health Insurance and Access to Care in U.S. Working-Age Adults Experiencing Long COVID

Long COVID encompasses a wide range of health problems that emerge, persist, or recur following acute coronavirus disease 2019 (COVID-19) illness. Given that the prevalence of self-reported Long COVID is highest among U.S. adults in their prime working years, it is important to identify unmet needs and gaps in healthcare access and coverage among working-age adults. Prevalences (95% confidence intervals [CI]) of health insurance coverage and access to care by Long COVID status were estimated among adults 18-64 years (n=18,117), accounting for survey design and weighted to the U.S. non-institutionalized population in the 2022 National Health Interview Survey. Analyses were conducted in 2023. Overall, 3.7% (95% CI 3.4, 4.0) of respondents were experiencing Long COVID. Adults experiencing Long COVID were less likely to report being uninsured relative to adults not experiencing Long COVID (p=0.004); however, 49.0% (95% CI 43.2, 54.7) had high deductible health plans. Adjusting for sociodemographic characteristics, adults experiencing Long COVID were more likely to access healthcare compared to adults not experiencing Long COVID (p<0.01 for seeing a doctor, telemedicine appointments, ≥2 urgent care visits, ≥2 emergency department visits, and hospitalized overnight). Despite more frequent healthcare use, adults experiencing Long COVID were also more likely to abstain from and delay medical care, therapy, and prescriptions due to cost compared to adults not experiencing Long COVID (p<0.0001 for all comparisons). These findings may be used to inform healthcare planning for adults experiencing Long COVID and highlight the ongoing need to improve access and affordability of quality and comprehensive care.

Identifying gaps in healthcare: a qualitative study of Ukrainian refugee experiences in the German system, uncovering differences, information and support needs

BackgroundThe 5.8 million Ukrainian refugees arriving in European countries must navigate varying healthcare systems and different and often unknown languages in their respective host countries. To date, there has been little exploration of the experiences, perceived differences, information and support needs of these refugees regarding the use of healthcare in Germany.MethodsWe conducted ten qualitative interviews with Ukrainian refugees living in Germany from February to May 2023, using Ukrainian, English and German language. The transcribed interviews were analysed using the qualitative content analysis method according to Kuckartz and Rädiker with the MAXQDA software.ResultsIn general, participants consistently had a positive experience of the German healthcare system, particularly regarding the quality of treatments and insurance. Differences have been reported in the structure of the healthcare systems. The Ukrainian healthcare system is divided into private and state sectors, with no mandatory insurance and frequent out-of-pocket payments. Pathways differ and tend to focus more on clinics and private doctors. General practitioners, often working in less well-equipped offices, have only recently gained prominence due to healthcare system reforms. Initiating contact with doctors is often easier, with much shorter waiting times compared to Germany. Interviewees often found the prescription requirements for many medications in Germany to be unusual. However, the mentioned differences in healthcare result in unmet information needs among the refugees, especially related to communication, navigating the healthcare system, health insurance, waiting times and medication access. These needs were often addressed through personal internet research and informal (social media) networks because of lacking official information provided during or after their arrival.ConclusionsDespite the positive experiences of Ukrainian refugees in the German healthcare system, differences in the systems and language barriers led to barriers using healthcare and information needs among refugees. The dissemination of information regarding characteristics of the German health care system is crucial for successful integration but is currently lacking.Trial RegistrationGerman Clinical Trials Register: DRKS00030942, date of registration: 29.12.2022.