Financial Assistance Programs Research Articles

Characteristics of Health Care Financial Assistance Programs Serving the Most Populous U.S. Counties.

County-based health care financial assistance programs offer improved access to health care for indigent populations by reducing or eliminating costs to receive care. We examined health care financial assistance programs serving the 10 most populous U.S. counties. We found that the percent enrollment in a county's program is strongly correlated with the percent uninsured (r=.86) and the percent undocumented (r=.83), and moderately correlated with the percent indigent (r=.43) in a county, suggesting the importance of health care financial assistance programs for these groups. Furthermore, the typical county-based health care financial assistance program covers the same income range (0-138% federal poverty level) and offers similar benefits (including coverage of emergency care and inpatient care) as Medicaid. Counseling services are frequently available to assist applicants. These characteristics allow them to serve as an alternative source of health care funding to those who are ineligible for Medicaid coverage.

Improved Healthcare Access Reduces Requirements for Surgery in Indigent IBD Patients Using Biologic Therapy: A 'Safety-Net' Hospital Experience.

Low socioeconomic status (SES) is associated with greater morbidity and increased healthcare resource utilization (HRU) in IBD. We examined whether a financial assistance program (FAP) to improve healthcare access affected outcomes and HRU in a cohort of indigent IBD patients requiring biologics. IBD patients (>18 years) receiving care at a ‘safety-net’ hospital who initiated biologics as outpatients between 1 January 2010 and 1 January 2019 were included. Patients were divided by FAP status. Patients without FAP had Medicare, Medicaid, or commercial insurance. Primary outcomes were steroid-free clinical remission at 6 and 12 months. Secondary outcomes were surgery, hospitalization, and ED utilization. Multivariate logistic regression was used to calculate odds ratio (OR) and 95% confidence interval (CI). Decision tree analysis (DTA) was also performed. We included 204 patients with 258 new biologic prescriptions. FAP patients had less complex Crohn’s disease (50.7% vs. 70%, p = 0.033) than non-FAP patients. FAP records indicated fewer prior surgeries (19.6% vs. 38.4% p = 0.003). There were no statistically significant differences in remission rates, disease duration, or days between prescription and receipt of biologics. In multivariable logistic regression, adjusting for baseline demographics and disease severity variables, FAP patients were less likely to undergo surgery (OR: 0.28, 95% CI [0.08–0.91], p = 0.034). DTA suggests that imaging utilization may shed light on surgical differences. We found FAP enrollment was associated with fewer surgeries in a cohort of indigent IBD patients requiring biologics. Further studies are needed to identify interventions to address healthcare disparities in IBD.

Tennessee Pharmacists' Opinions on Barriers and Facilitators to Initiate PrEP: A Qualitative Study.

Pre-exposure prophylaxis (PrEP) is recommended to prevent the transmission of the human immunodeficiency virus (HIV). Although an effective treatment, the uptake in the United States remains low. Pharmacists are well-positioned to initiate the conversation with patients about PrEP, but few studies exist exploring their unique roles. The objective of this study was to characterize Tennessee pharmacists’ perceptions about access to PrEP. A qualitative study was used to gather the data that consisted of virtual Focus Groups over four months in 2021 from practicing Tennessee pharmacists. Emails were sent to all Tennessee licensed pharmacists to recruit them to participate in the study. Recruitment continued until Thematic Saturation was obtained. The corpus of data was audio-recorded, transcribed, and analyzed by the research team. Thematic Analysis revealed two themes: (1) Barriers to accessing PrEP; (2) Potential solutions to address barriers identified. These findings highlighted barriers and identified solutions to improve access to PrEP in Tennessee; additional financial assistance programs and marketing programs targeting patients and providers are needed to enhance PrEP access.

Entrepreneurial Engagement of the Tertiary Education Subsidy (TES) Grantees in Central Philippines State University

The Unified Student Financial Assistance System for Tertiary Education or UniFAST is the government agency in charge of implementing the Universal Access to Quality Tertiratry Education Act (RA 10931). The UniFAST was created in 2015 by virtue of RA 10687 as a system to unify existing government student financial assistance programs for Tertiary Education in the Philippines. It will ensure that deserving Filipinos are given equitable access to educational opportunities. One of these, the Tertiary Education Subsidy or TES. Subsidy as a form of financial assistance plays an important role to augment financial incapacities of students enrolled in Higher Education Institutions or HEIs (Avery, 2014). Through RA 10931 which was passed into law on August 3, 2017, the citizens were allowed full access to quality education by providing adequate funding and increasing participation rate in the tertiary education. This further gives chances to the poor but deserving students to reach their goals and finish a degree. The Implementing Rules and regulations (IRR) of this law recognizes the complementary roles of public and private Higher Educations Institutions and Technical-Vocational Institutions in the tertiary education system, and the invaluable contribution of private tertiary institutions to the education system. As been embedded in our Philippine Constitution, the quality education is an inalienable right of all Filipinos and it is the policy of the State to protect and promote the rights of students to quality education at all levels. Keywords: tertiary education subsidy, grantees, entrepreneurial, engagement

Identifying symptoms/illnesses and situations that predispose outpatients to use antibiotics in two healthcare systems

Background: Taking antibiotics outside the guidance of a clinician (nonprescription use) is a potential safety issue and runs counter to antibiotic stewardship efforts. We identified the symptoms and illnesses and situations that may predispose patients to take antibiotics, and we compared these findings between patients attending public primary care clinics and private emergency departments. Methods: A cross-sectional survey was conducted between January 2020 and March 2021 in 6 primary care clinics and 2 emergency departments in the United States. We queried patients about 5 symptoms and illnesses (Fig. 1) and 14 situations (Fig. 2) to investigate whether these would lead the patients to take antibiotics without a prescription. We used the χ2 test to compare the symptoms and illnesses and situations between the respondents from public and private healthcare systems. We set the P value for significance at <.025. Results: In total, the survey had 564 respondents (median age, 49.7 years; range, 19–92), and 72% were female. Most respondents identified as either Hispanic or Latina/Latino (46.6%) or African American or Black (33%), followed by White (15.8%), and other (4.6%). Most respondents had visited public clinics (72%). The most common insurance status for our respondents included Medicaid or county financial assistance program (56.6%), followed by private insurance or Medicare (36.7%) and self-pay (6.7%). In public primary care clinics, only 23% had private insurance or Medicare compared to 72.9% in private emergency departments. Of those surveyed, 69% agreed that antibiotics would improve the recovery from sinus infections, followed by bronchitis (64%), sore throat (64%), cold/flu (61.4%), and diarrhea (31.5%). The proportions of respondents who believed that antibiotics would improve the recovery from diarrhea (36.2% vs 19.4%; P = .004) and sore throat (59.9% vs 48.4%; P < .001) were significantly higher among public versus private outpatient respondents. We did not find significant differences for cold/flu, sinus infection, or bronchitis between these 2 healthcare systems (Fig. 1). In 11 of the 14 situations, patients in public clinics were more likely to report a likelihood of using nonprescription antibiotics than the patients visiting the private emergency rooms (Fig. 2). Conclusions: Future stewardship interventions should be aware of the symptoms and illnesses and situations that may influence outpatients to take nonprescription antibiotics. Addressing modifiable factors (eg, leftover antibiotics, antibiotics given by friends or family, and antibiotics available without a prescription in stores or markets) may also curtail these unsafe practices and reduce antibiotic resistance.Funding: NoneDisclosures: None

Understanding Household Vulnerability and Relative Poverty in Forestry Transition: A Study on Forestry-Worker Families in China’s Greater Khingan Mountains State-Owned Forest Region

China’s logging ban policy has profoundly transformed the forestry industry, creating substantial impacts for forestry-worker households. Empirical evidence is needed to examine whether and how severe the transition policy produces vulnerability and relative poverty for the affected households. This paper samples forestry-worker households from the Greater Khingan Mountains state-owned forest region as the study subjects to evaluate their household vulnerabilities with the LVI approach proposed by IPCC. This study computes the relative poverty scores of the families and further identifies the relationships between the selected household’s socio-economic factors and the estimated vulnerability and poverty scores with OLS regression. This study derives a sleuth of valuable points. (1) The majority of the forestry-worker households have had to suffer downsized, vulnerable livelihoods with escalated relative poverty due to the policy’s impact. (2) Poverty closely connects with vulnerability, where the more impoverished the household, the more vulnerable it is. Poverty is, however, not the only factor affecting household vulnerability. Other factors, particularly of public and social-financial factors, are interconnected with poverty and, thus, compound the vulnerability issue. (3) Factors, e.g., family size, age and gender of household head, bank deposits, and life and job satisfaction, which are typically very beneficial for improving family vulnerability and poverty. (4) Regular financial assistance programs, particularly the commonly-trusted one-off household compensation program, might not provide solid support for addressing long-term household vulnerability and poverty. This study contributes to a broader understanding of household vulnerability and relative poverty for improved policy and program development addressing forestry workers and household vulnerabilities.

Knowledge And Attitudes Of Implantable Cardioverter Defibrillators In A Diverse Patient Population Nearing End Of Life

Background While prior assessments of ICD knowledge have consistently demonstrated poor patient understanding, these analyses lack diversity. This is a critical shortcoming, particularly for patients at end of life, as differences in goals of care at end of life exist between different races and ethnicities. Objective To evaluate patient ICD knowledge and perceptions in a diverse patient population with defibrillators nearing end of life. Design Cross sectional analysis and telephone survey of patients with ICDs at a single center, within a large safety net county healthcare system. Patients within an existing palliative care registry were selected for inclusion, based on presence of an ICD as seen in Figure 1. Results A total of 113 patients met criteria for retrospective chart review. Patient demographics were 48% black, 26% Hispanic. Regarding funding status, 35% were uninsured, participated in the financial assistance program or had Medicaid (Table 1). Eight months following chart review, 44 patients had died (39%). Of the surviving patients, 26 (38%) completed the survey. Patients scored numerically worse on ICD knowledge questions compared to a prior study population. Lower knowledge scores were not associated with race or ethnicity. The majority of survey participants (69%) were unaware that ICD deactivation does not require surgery and nearly all (88%) said no that doctor had ever discussed the option of ICD deactivation. Conclusion Vulnerable and diverse patients nearing end of life may have worse understanding of ICDs than previously described patients. Decreased knowledge did not correlate with race or ethnicity. Challenges in healthcare delivery in this patient population may result in our most vulnerable patients being poorly equipped to align their ICD settings with goals of care when nearing end of life. While prior assessments of ICD knowledge have consistently demonstrated poor patient understanding, these analyses lack diversity. This is a critical shortcoming, particularly for patients at end of life, as differences in goals of care at end of life exist between different races and ethnicities. To evaluate patient ICD knowledge and perceptions in a diverse patient population with defibrillators nearing end of life. Cross sectional analysis and telephone survey of patients with ICDs at a single center, within a large safety net county healthcare system. Patients within an existing palliative care registry were selected for inclusion, based on presence of an ICD as seen in Figure 1. A total of 113 patients met criteria for retrospective chart review. Patient demographics were 48% black, 26% Hispanic. Regarding funding status, 35% were uninsured, participated in the financial assistance program or had Medicaid (Table 1). Eight months following chart review, 44 patients had died (39%). Of the surviving patients, 26 (38%) completed the survey. Patients scored numerically worse on ICD knowledge questions compared to a prior study population. Lower knowledge scores were not associated with race or ethnicity. The majority of survey participants (69%) were unaware that ICD deactivation does not require surgery and nearly all (88%) said no that doctor had ever discussed the option of ICD deactivation. Vulnerable and diverse patients nearing end of life may have worse understanding of ICDs than previously described patients. Decreased knowledge did not correlate with race or ethnicity. Challenges in healthcare delivery in this patient population may result in our most vulnerable patients being poorly equipped to align their ICD settings with goals of care when nearing end of life.

Eliminating Barriers to Youth Sport in Greenville, North Carolina

This case study helps students better understand barriers to youth sport participation that low-income families face and then offer solutions to alleviate some barriers and create a more inclusive sport community. The case focuses on the struggle that many sport organizations face when trying to increase diversity and inclusiveness, regardless of socioeconomic status. Greenville Recreation and Parks Department Development Intern Sarah identifies issues with the department’s current financial assistance program and collects parents’ feedback detailing community needs that are not being met. This case provides an opportunity for students to (a) examine how sport organizations unintentionally create barriers for some community members and (b) find innovative ways to reduce barriers to youth sport participation and create more inclusive systems.

Clinical Team Response to the Impact of COVID-19 on Diabetes Self-Management: Findings From a Qualitative Study.

The aims of this study were to explore providers' perceptions of how COVID-19 affected patients' psychological wellbeing and diabetes self-care and discover how providers responded to sustain and improve patients' psychological health and diabetes management during the pandemic. Twenty-four semi-structured interviews were completed with primary care providers (n=14) and endocrine specialty clinicians (n=10) across sixteen clinics in North Carolina. Interview topics included: (1) current glucose monitoring approaches and diabetes management strategies for people with diabetes (2) barriers and unintended consequences encountered with respect to diabetes self-management, and (3) innovative strategies developed to overcome barriers. Interview transcripts were coded using qualitative analysis software and analyzed to identify cross-cutting themes and differences between participants. Primary care providers and endocrine specialty clinicians reported that people with diabetes experienced increased mental health symptoms, increased financial challenges and positive and negative changes in self-care routines due to COVID-19. To offer support, primary care providers and endocrine specialty providers focused discussions on lifestyle management and utilized telemedicine to connect with patients. Additionally, endocrine specialty clinicians helped patients access financial assistance programs. Findings indicate that people with diabetes experienced unique challenges to self-management during the pandemic and providers responded with targeted support strategies. Future research should explore the effectiveness of these provider interventions as the pandemic continues to evolve.

EP466: The use of next generation prenatal screening in a low resource setting among Non-Hispanic Black and Hispanic patients

Just under half of all births in the U.S. are covered under Medicaid insurance. Increasingly, many state public health programs offer noninvasive prenatal screening (NIPS) as first-tier prenatal screening covered under Medicaid insurance or through contracts with private companies. Yet considerable questions remain regarding the cost-effectiveness of NIPS vs. maternal serum screening and its use in a low-health literacy, low-resource population. In order to explore pregnant patient’s views and understanding of prenatal screening, we conducted a qualitative interview study with patients at a federally qualified health center. We recruited from prenatal and maternal-fetal medicine clinics at the University of Florida Jacksonville (UF Health). UF Health offers NIPS to their prenatal patients upon provider recommendation. Patients were included if they were age 18 or older, identified as Black or African American and/or Hispanic or Latina, were currently pregnant, or were pregnant within the past 12 months, and spoke English or Spanish. Interviews were conducted using a semi-structured interview guide and were audio recorded and transcribed verbatim. NVivo12 was used to analyze interview transcripts according to standard qualitative methodology using a grounded theory framework. Eighty-seven patients completed an interview, including 54 (62.1%) non-Hispanic Black, 30 (31.3%) Hispanic, and 3 (3.4%) Hispanic/Black patients. The majority were covered under Medicaid insurance (n=65, 74.7%) followed by private insurance (n=8, 9.2%), financial assistance program (n=2, 2.3%), Tricare/VA Healthcare (n=2, 2.3%), and uninsured/self-pay (n=2, 2.3%). Most participants stated that they had received NIPS and understood its primary utility as determining fetal sex, however, some understood that they were also being tested for Trisomy 21. Some participants indicated that they had NIPS, but their responses reflected that they received quad screening only or vice versa. Pre-test counseling was described as brief, with a few women expressing that the test was mandatory requirement for their prenatal care. Few participants were counseled that a positive screening result would need to be confirmed by chorionic villus sampling, amniocentesis, or umbilical cord blood sampling. No participants were able to recall a chromosomal condition other than Trisomy 21 included in the NIPS panel, but most expressed a perception that they were being tested to rule out fetal anomaly. Many indicated a belief that they were being tested for multifactorial conditions, such as autism, or for developmental delay more broadly. Most participants felt that NIPS was useful for prenatal preparation, such as learning more information about the condition and future medical needs of their child. Only a couple participants indicated they would use NIPS results for a pregnancy continuation decision, with most stating that they intended to continue with the pregnancy regardless of the screening result. Some stated that they were not intimidated by the prospect of having a child with a genetic condition or disability since they worked with children with special needs or had a family member with a similar condition. To the best of our knowledge, this is the largest qualitative study on NIPS in an underserved Black and Hispanic population. Our findings suggest that many underserved patients are unable to make a meaningful distinction between NIPS and maternal serum screening and are not adequately counseled on its scope, limitations as a screening vs. diagnostic test, and implications in the event of a positive result, in accordance with professional guidelines. In contrast to arguments stating that cost-effectiveness of NIPS is supported through elective termination of affected pregnancies, most women stated that they did not intend to use their result for this purpose. These findings indicate that the use of NIPS as a first-tier prenatal screen for fetal aneuploidy may not be appropriate without additional public health investment. Additional resources are also needed to ensure that providers are able to adequately educate and counsel patients with low health literacy on NIPS to meet shared decision-making standards.

The Impact of Portuguese Economic and Financial Assistance Program on the Employability of the Azorean Nurse after the Financial Crisis of 2009-2010

The economic crisis that followed the financial crisis that began in the United States of America in 2008 quickly spread to the whole world, leaving structural problems in several countries unveiled, particularly in those that, due to successive deficits and high external indebtedness, were in a more fragile situation. In the Portuguese case, external assistance was needed, made available in exchange for structural reforms and the abrupt, and severe reduction in public expenditure. The applied austerity had repercussions throughout society, but the public sector felt the weight of the used measures concretely, with health services being no exception. The shock waves caused by public expenditure containment policies were particularly felt in the Azores, an ultra peripheral region marked by geographical discontinuity. These are significant asymmetries at various levels from island to island and across several sectors. The public sector is the primary employer. This paper focuses on understanding if the Portuguese Economic and Financial Assistance Program, implemented between 2011 and 2014, affected the employability and dynamics of the labour market of new graduate nurses in the Autonomous Region of the Azores. This quantitative study used descriptive, inferential, and correlation statistics to establish relations with a statistical value between the sample's employability dimensions and the Portuguese Economic and Financial Assistance Program. From the analysis carried out, the study revealed that the restrictions imposed due to the external assistance program led to an increase in precariousness among new graduate nurses and, among other conclusions, a strong contraction in the capacity of hiring nurses by the public health services. As a limitation to the study, there is the need to emphasise that data on unemployment reflected the reality when the questionnaire was applied (May 2019), and the fact that the study did not explore the reasons underlying the unemployment rate found among the participants (although residual).

Abstract P2-09-09: Genetic assessment of hereditary breast and ovarian cancer in the Smith Clinic: A 10-year, single center experience

Abstract Background: Highly penetrant pathogenic variants causing hereditary breast and ovarian cancer syndrome occur among patients of racial/ethnic minorities at least as frequently as they do among non-Ashkenazi Jewish, non-Hispanic White patients. However, studies suggest that disparities persist in genetic counseling and testing in these populations. It is critical that we reduce the testing gap to better understand genetic susceptibility in minority patients and identify individuals who may benefit from preventive and therapeutic interventions. We explore genetic counseling and testing outcomes in a safety net system with significant support from financial assistance programs that minimizes typical financial and insurance barriers. Methods: This is a retrospective study of adult patients evaluated by a genetic counselor for hereditary breast/ovarian cancer syndrome between October 1, 2009 and September 30, 2019 in Smith Clinic, which is part of a large, county hospital system serving predominantly racial/ethnic minority and uninsured or under-insured patients, and affiliated with the Dan L Duncan Comprehensive Cancer Center. All patients between October 1, 2009 and February 28, 2013 underwent genetic testing, whereas all patients after March 1, 2013 were evaluated by a genetic counselor but may not have completed testing. Patient clinical data was summarized using descriptive statistics. Results: 1,682 patients (mean age at time of counseling/testing 48.2 years) were evaluated by a genetic counselor. Patient-reported race/ethnicity was 58.7% Hispanic, 25.2% non-Hispanic Black (NHB), 8.8% non-Hispanic White (NHW), 4.6% Asian, and 2.7% other with 2.6% having some Native American and 0.6% having any Ashkenazi Jewish genealogic ancestry. Among the 1,397 patients who completed genetic testing, 76.2% received financial assistance. The majority were tested with a multigene panel (70.4%) with the remaining primarily undergoing BRCA sequencing or BRCA large rearrangement test (multigene panels not available until April 2014). More than three-quarters of patients who did not complete testing (n=285, 20.6% of those evaluated after March 1, 2013) did not meet guideline-based criteria or had a relative who was a more appropriate candidate for testing. Only 10.2% declined testing with rates of decline highest among NHB patients. A pathogenic mutation was found in 15.4% of individuals tested: BRCA1 (n=108), BRCA2 (n=57), PALB2 (n=26), ATM (n=8), other (n=18). Rates of pathogenic mutations were higher among NHW and Hispanic patients (NHW 14.9%, Hispanic 17.4%, NHB 11.3%, Asian 9.0%, Other 17.1%). The relatively high percentages of identified pathogenic mutations was likely related to the fact that 84.1% of patients were referred for a personal history of breast and/or ovarian cancer with 6.1% of NHW and 5.7% of Hispanic patients referred for a relative with or personal history of a known pathogenic mutation. Among those with BRCA1/2 or PALB2 mutations, risk-reducing procedures were frequent among all races except those classified as other (mastectomies: NHW 50%, NHB 45.5%, Hispanic 51.9%, Asian 40%, other 16.7%; salpingo-oophorectomies or salpingectomies: NHW 35.7%, NHB 45.5%, Hispanic 56.4%, Asian 60%, other 16.7%). Conclusions: In a racially/ethnically diverse, low-income population, genetic testing uptake is high when supported by financial assistance programs and an on-site genetic counselor. Regardless, reasons for declining testing warrant further exploration, particularly among non-Hispanic Black patients, to further reduce disparities in testing. Prompt referral of patients who meet testing guidelines for genetic evaluation is also critical since pathogenic mutations were frequently identified in all racial/ethnic subgroups and nearly half underwent a risk-reducing procedure. Citation Format: Nicole Higashiyama, Shaun Bulsara, Susan Hilsenbeck, Tiffaney Tran, Ria Brown, Mary Fang, Cathy Sullivan, Georgiann Garza, Maryam Nemati Shafaee, C. Kent Osborne, Mothaffar Rimawi, Julie Nangia. Genetic assessment of hereditary breast and ovarian cancer in the Smith Clinic: A 10-year, single center experience [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-09-09.

Keeping citizens living with low incomes at arm’s length away: the responsibilization of municipal recreation access provisions

ABSTRACT Through the lens of neoliberalism, the purpose of this paper is to illustrate the techniques of responsibilization in municipal recreation access provisions. Using data from interviews with 16 municipal recreation administrators in Atlantic Canada, we trace responsibilization through fiscal policies and administration schemes characterizing four neoliberalism tenets: privatization, efficiency, individualism, and accountability. Our findings identified four techniques of responsibilization embedded in access provisions for low-income citizens: 1) privatizing recreation provisions by off-loading programming responsibility; 2) not advertising financial assistance programmes and other informal financial support; 3) assuming accessing financial assistance programs is easy, and 4) verifying low-income status. The responsibilization inherent in these access provisions cultivates relational distance, which we suggest challenges the provisions’ ‘accessible’ nature.

Renewable jet fuel supply chain network design: Application of direct monetary incentives

Currently, the global aviation industry uses around 341 billion liters of jet fuel per year, with demand predicted to grow by 50% by the end of 2050. Renewable jet fuel (RJF) may cut greenhouse gas emissions (GHG), increase fuel diversity for the aviation industry, and promote rural economies. The commercialization of RJF has been delayed due to a shortage of sustainable biomass resources. This study recommends using winter carinata crops as a reliable biomass feedstock in the southeastern US states, where the availability of resources will be investigated in each agricultural zone. RJF production is more expensive than traditional jet fuel production. Investors and legislators need to learn more about prospective federal financial initiatives, such as subsidies and grants, to help with RJF supply chain implementation. In this paper, using a mathematical programming approach, we designed an RJF supply chain and then investigated the effects of three direct monetary incentive programs, including producer credit program (PCP), biomass crop assistance program (BCAP), and biorefinery assistance program (BAP), to accelerate the commercialization of RJF manufacturing. According to the findings, the amount of incentives through PCP needed to fulfill 50% of the RJF demand was assessed to cover 16.70% of the total costs, while the BCAP could reach the commercialization threshold by receiving incentives for 22.84% of the biomass purchasing cost. Furthermore, having the BAP covering 89.39% of the annual capital and operating costs could help commercialize RJF production. This study also evaluated the effects of changes in renewable fuel prices, demand fulfillment rates, biomass yield rates, and the price of biomass feedstock and its resulting meal on the profitability of the supply chain. The study's findings will advise policymakers and investors on developing the RJF supply chain given various financial assistance programs and subsidies.

Risk Aversion and Timber Harvest Strategies: A Case Study of Nonindustrial Private Forest Management in Louisiana

Forest owners face many challenges regarding forest management due to the long period from planting to harvest. Along with the economic and environmental factors that influence management actions, the owners' attitude to risk plays a crucial role in forest management decisions. This study shows that understanding the effects of the owner's risk preference for management actions is an important step to form an effective forest policy. The objectives of the study are to (1) assess the economic advantage of forest management alternatives over a range of risk aversion coefficients and (2) determine the financial incentive (risk premium) corresponding to a forest owners' risk attitude. We implemented the stochastic efficiency with respect to a function framework to evaluate a set of fertilization, herbicide, and thinning management alternatives at mid-rotation loblolly pine plantations in Louisiana. Results from this study indicate that forest owner's risk preference affects their decision to select management actions. Financial incentives are substantially different for specific management alternatives between risk-neutral and risk-averse forest owners. The results can guide forest policy development where agencies can modify financial assistance programs to improve the adoption of management actions.

Russia — Honduras: what are we looking for in a far country?

The article is devoted to the Russia’s current relations with one of the most disadvantaged countries in Latin America – Honduras. The author aims to answer the question: does Moscow need to develop it? It turned out that it was not so easy to find the answer; to do this, it was necessary to study the political and economic situation in the country itself, assess its relations with the United States, find out who we are dealing with in the person of S. Castro, who came to power in 2022, and study the history of the establishment and development of Russian-Honduran relations. Only after completing these tasks it was possible to formulate clear recommendations, outline a possible future and identify "weaknesses" in the Russian-Honduran dialogue. The answer to the main question is still positive. Moreover, Russian-Honduran relations have good prospects for both sides, in particular, for their foreign policy and diplomacy. The author used a variety of sources: from reports of the Carnegie Endowment, the National Statistical Agency of Honduras, official documents of government departments to publications of ECLAC, the largest Honduran and world media, newspapers, scientific journals and special publications devoted to Honduras, its foreign and domestic policy. The key methodology used is an institutionalist and behaviorist approach, comparative analysis, as well as partially content and event analysis. The novelty of the article lies in the fact that the author writes for the first time in the scientific literature about the possible unfair use of US financial assistance programs to foreign states in order to enrich individual bureaucratic elites both in Washington and in Tegucigalpa.

Care of the Immigrant Child.

Care of the Immigrant Child.

Risk factors for financial toxicity in patients with gynecologic cancer

The cost of cancer care is high and rising. Evidence of increased patient cost burden is prevalent in the medical literature and has been defined as "financial toxicity," the financial hardship and financial concerns experienced by patients because of a disease and its related treatments. With targeted therapies and growing out-of-pocket costs, patient financial toxicity is a growing concern among patients with gynecologic cancer. This study aimed to determine the prevalence of financial toxicity and identify its risk factors in patients with gynecologic cancer treated at a large cancer center using objective data. Using institutional databases, we identified patients with gynecologic cancer treated from January 2016 to December 2018. Patients with a preinvasive disease were excluded. Financial toxicity was defined according to institutionally derived metrics as the presence of ≥1 of the following: ≥2 bills sent to collections, application or granting of a payment plan, settlement, bankruptcy, financial assistance program enrollment, or a finance-related social work visit. Clinical characteristics were gathered using a 2-year look-back from the time of the first financial toxicity event or a randomly selected treatment date for those not experiencing toxicity. Risk factors were assessed using chi-squared tests. All significant variables on univariate analysis were included in the logistic regression model. Of the 4655 patients included in the analysis, 1155 (25%) experienced financial toxicity. In the univariate analysis, cervical cancer (35%), stage 3 or 4 disease (24% and 30%, respectively), younger age (35% for age <30 years), nonpartnered marital status (31%), Black (45%) or Hispanic (37%) race and ethnicity, self-pay (48%) or commercial insurance (30%), clinical trial participation (31%), more imaging studies (39% for ≥9), ≥1 emergency department visit (36%), longer inpatient stays (36% for ≥20 days), and more outpatient clinician visits (41% for ≥20 visits) were significantly associated with financial toxicity (P<.01). In multivariate analysis, younger age, nonpartnered marital status, Black and Hispanic race and ethnicity, commercial insurance, more imaging studies, and more outpatient physician visits were significantly associated with financial toxicity. Financial toxicity is an increasing problem for patients with gynecologic cancer. Our analysis, using objective measures of financial toxicity, has suggested that demographic factors and healthcare utilization metrics may be used to proactively identify at-risk patients for financial toxicity.

The contribution of tax expenditure in fiscal consolidation in post-crisis economies: a case study of the context in Portugal

In this research, we analyse the use of fiscal expenditure as an instrument of fiscal consolidation policy. Portugal was subject to the financial assistance programme (PAEF) articulated with the IMF, the European Commission and the European Central Bank between 2010 and 2014. The objective is to analyse the evolution of fiscal expenditure in the following four years, after the end of that term programme, that is, between 2015-2018. The outcome is to know if the policy of reducing fiscal expenditure implemented in the years in which the programme was in force (2010-2014), continued into the following four years. We compared this evolution with the evolution of direct expenditure, based on two main axes: economic expenditure and social expenditure. The data collection technique is used through document research, and the data obtained was from information provided by national, European statistical authorities and secondary sources of information. It is concluded that, in the 2014-2018 period, the increase in public revenue, due to the decrease in tax expenditure, did not evolve consistently. In 2014-2018, direct public expenditure did not follow the same pattern as in the previous years of 2011-2014, given the functional equivalence of the two types of expenditure. Finally, to observe the relationship between the level of fiscal consolidation, carried out between the years 2010 and 2018, and the behaviour of tax revenue and expenditure, the Scheffé test was performed on the averages of the variables Total Revenue and Expenditure, and Tax Revenue and Expenditure. This was applied in order to observe if the averages of the variables are significantly relevant for the level of fiscal consolidation or if there are other variables, equally important, that were not taken into account in the study, but that had a preponderant role (such as the economic context). We have to statistically conclude that both the revenue and expenditure averages and the percentage averages are not all equal, as they are, in fact, all different between the groups analysed. In order to clarify if the differences in revenue and expenditure and in the respective percentages are statistically significant or if, on the contrary, they are merely eventual, we previously verified their applicability through the assumptions of normality and homoscedasticity of each of the data sets, using the ANOVA test (Fisher, 1918). We observed that for both the amounts of revenue and expenditure, as well as the percentages, the p-value observed in the ANOVA test was equal to 0.000 (i.e. less than 0.050), implying the rejection of the null hypotheses and the acceptance of the alternative hypotheses, according to which the average values of the amounts of revenue and expenditure, and the average values of the percentages are not all equal. The general conclusion is that there was budget consolidation, but this must have been due to other factors, such as the economic environment, since there is no direct relationship between revenue, fiscal expenditure and budget consolidation in any of the periods studied.

Abstract 14545: Prevalence of Medication Non-Adherence via Therapeutic Drug Monitoring in Patients With Uncontrolled Hypertension Treated at a Safety Net Hospital

Background: Medication nonadherence presents one of the greatest challenges to hypertension management. Previous studies from our group have shown therapeutic drug monitoring (TDM), biochemical monitoring of drug levels, is more accurate than self-report, detailed questionnaires, or prescription fill rate in detecting nonadherence. Prior studies have also shown a prevalence of nonadherence from 45% to 80% among insured patients with uncontrolled hypertension despite having been prescribed a multi-drug regimen. Previous studies have not assessed adherence to antihypertensive drugs in a safety net population by TDM. Methods: We performed a cross-sectional study in patients with uncontrolled hypertension in the primary care Internal Medicine and Cardiology Clinics at Parkland Health&amp; Hospital System (PHHS). Patients with BP of ≥130/80 mmHg, prescribed ≥2 antihypertensive medications, and self-reporting medication adherence were enrolled after informed consent. Plasma samples were obtained for measurement of 44 cardiovascular drugs using liquid chromatography mass spectrometry. Results: Among 77 patients with uncontrolled hypertension (57% female, 65% Black, 12% Hispanic), 13 (17%) were nonadherent to at least one anti-hypertensive drug by TDM. The adherent and nonadherent groups had similar systolic (146±13 vs 148±18, p=0.67) and diastolic (83±9 vs 88±10 mmHg, p=0.13) BP. All patients had either medical insurance or some form of prescription financial assistance. Sixty two patients had insurance, while 15 had prescription financial assistance. Nonadherence rates for patients on financial assistance programs did not significantly differ from patients with medical insurance (13% vs 18%, p&gt;0.999). Conclusions: We found a surprisingly low prevalence of anti-hypertensive medication nonadherence in this uncontrolled hypertension population despite many barriers to treatment. Our study suggests a lesser role of medication nonadherence in uncontrolled hypertension in the safety net population.