Gaps In Health Coverage Research Articles

Explaining racial and ethnic disparities in antiretroviral therapy adherence and viral suppression among U.S. men who have sex with men.

To identify factors - including social determinants of health (SDOH) - that explain racial/ethnic disparities in antiretroviral therapy (ART) adherence and sustained viral suppression (SVS) among U.S. men who have sex with men (MSM) with HIV. We used weighted data from 2017-2021 cycles of the Medical Monitoring Project. Among MSM taking ART, we calculated prevalence differences (PDs) with 95% confidence intervals (CIs) of ART adherence (100% ART adherence, past 30 days) and SVS (all viral loads in past 12 months <200 copies/ml or undetectable) for Black MSM (BMSM) and Hispanic/Latino MSM (HMSM) compared with White MSM (WMSM). Using forward stepwise selection, we calculated adjusted PDs with 95% CIs to examine if controlling for selected variables reduced PDs. After adjusting for age, any unmet service need, federal poverty level (FPL), food insecurity, homelessness, time since HIV diagnosis, gap in health coverage, and education, the BMSM/WMSM PD for ART adherence reduced from -16.9 to -8.2 (51.5%). For SVS, the BMSM/WMSM PD reduced from -8.3 to -3.6 (56.6%) after adjusting for ART adherence, age, homelessness, food insecurity, gap in health coverage, FPL, any unmet service need, time since diagnosis, and ER visit(s). The HMSM/WMSM PD for ART adherence reduced from -9.3 to -2.9 (68.8%) after adjusting for age and FPL. The unadjusted HMSM/WMSM PD for SVS was not statistically significant. Adjusting for SDOH and other factors greatly reduced racial/ethnic disparities in ART adherence and SVS. Addressing these factors - particularly among BMSM - could substantially improve health equity among MSM with HIV.

Gaps in health coverage for racialized im/migrant sex workers in metro Vancouver: Findings of a community-based cohort study (2014–2021)

BackgroundSex workers face substantial health inequities related to sexual health and gender-based violence, many of which are amplified for the large proportion of workers who are racialized im/migrants. While criminalization and stigma are known barriers to health care for this population, we know little about health insurance coverage, and in particular how this relates to im/migration experience and racialization. We examined associations between im/migration status, duration, and racialization on gaps in health insurance coverage in a cohort of women sex workers. MethodsAnalyses used data from a prospective, community-based cohort of women sex workers in Vancouver, BC (Sept 2014-August 2021). Interviewer-administered questionnaires were by experiential (current/former sex workers) and community-based staff. We developed multivariable logistic regression confounder models with generalized estimating equations (GEE) to examine associations between migration and racialization exposures of interest and health insurance coverage. ResultsOf 644 sex workers, 411 (63.8%) reported lacking health insurance coverage for services needed during the 7-year study. In multivariable GEE analysis, precarious im/migration status (adjusted odds ratio (AOR) 2.37, 95% confidence interval (CI) 1.56 – 3.60), recent (AOR 4.22, 95% CI 2.42 – 7.35) and long-term (AOR 2.13, 95% CI 1.54 – 2.96) migration, and being a racialized Asian im/migrant (AOR 3.06, 95% CI 2.14 – 4.39) were associated with recent lack of health insurance coverage. ConclusionPolicy and program reforms are needed to decouple health insurance access from immigration status, remove mandatory waiting periods for health insurance coverage, and ensure that provincial insurance provides sufficient coverage for marginalized women's healthcare needs.

Prevalence and correlates of herbal medicine use among Anti-Retroviral Therapy (ART) clients at Queen Elizabeth Central Hospital (QECH), Blantyre Malawi: a cross-sectional study.

There has been an unprecedented explosion in the popularity of herbal preparations during the last few decades. Herbal medicines are commonly used by HIV/AIDs clients. There is limited data on the prevalence of herbal medicine and correlating factors of herbal medicine use in Malawi. This study establishes prevalence and factors contributing to the use of herbal medicine among HIV/AIDS clients attending the ART clinic at QECH, Blantyre Malawi. A cross-sectional study design was used to interview 211 conveniently sampled clients at QECH ART clinic. The questionnaire addressed socio-demographic, clinical characteristics, NCD-HIV comorbidity, and herbal medicine utilization. The main outcome of the study was herbal medicine use since the initiation of ART. Logistic regression analysis was done in Stata version 16. Both unadjusted and adjusted models were fitted for potential confounders. The prevalence of use of herbal medicine was reported in 17.5% (n=37) of the ART clients. The adjusted logistic regression analysis showed that urban residence was statistically associated with reduced use of herbal medicine (adjusted Odds Ratio - AOR: 0.04, 95% CI: 0.169, 0.976). There is a high prevalence of use of herbal medicine among clients taking ART. Herbal Medicine has the potential to cover the gaps in health coverage in rural communities.

Private health care market shaping and changes in inequities in childhood diarrhoea treatment coverage: evidence from the analysis of baseline and endline surveys of an ORS and zinc scale-up program in Nigeria

BackgroundNearly 90,000 under-five children die from diarrhoea annually in Nigeria. Over 90% of the deaths can be prevented with oral rehydration salt (ORS) and zinc treatment but coverage nationally was less than 34% for ORS and 3% for zinc with wide inequities. A program was implemented in eight states to address critical barriers to the optimal functioning of the health care market to deliver these treatments. In this study, we examine changes in the inequities of coverage of ORS and zinc over the intervention period.MethodsBaseline and endline household surveys were used to measure ORS and zinc coverage and household assets. Principal component analysis was used to construct wealth quintiles. We used multi-level logistic regression models to estimate predictive coverage of ORS and zinc by wealth and urbanicity at each survey period. Simple measures of disparity and concentration indices and curves were used to evaluate changes in ORS and zinc coverage inequities.ResultsAt baseline, 28% (95% CI: 22–35%) of children with diarrhoea from the poorest wealth quintile received ORS compared to 50% (95% CI: 52–58%) from the richest. This inequality reduced at endline as ORS coverage increased by 21%-points (P < 0.001) for the poorest and 17%-points (P < 0.001) for the richest. Zinc coverage increased significantly for both quintiles at endline from an equally low baseline coverage level. Consistent with the findings of the pairwise comparison of the poorest and the richest, the summary measure of disparity across all wealth quintiles showed a narrowing of inequities from baseline to endline. Concentration curves shifted towards equality for both treatments, concentration indices declined from 0.1012 to 0.0480 for ORS and from 0.2640 to 0.0567 for zinc. Disparities in ORS and zinc coverage between rural and urban at both time points was insignificant except that the use of zinc in the rural at endline was significantly higher at 38% (95%CI: 35–41%) compared to 29% (95%CI, 25–33%) in the urban.ConclusionThe results show a pro-rural improvement in coverage and a reduction in coverage inequities across wealth quintiles from baseline to endline. This gives an indication that initiatives focused on shaping healthcare market systems may be effective in reducing health coverage gaps without detracting from equity as a health policy objective.

Exploring wealth-related inequalities in maternal and child health coverage in Latin America and the Caribbean

BackgroundMaternal and child health have shown important advances in the world in recent years. However, national averages indicators hide large inequalities in access and quality of care in population subgroups. We explore wealth-related inequalities affecting health coverage and interventions in reproductive, maternal, newborn, and child health in Latin America and the Caribbean.MethodsWe analyzed representative national surveys from 15 countries conducted between 2001 and 2016. We estimated maternal-child health coverage gaps using the Composite Coverage Index – a weighted average of interventions that include family planning, maternal and newborn care, immunizations, and treatment of sick children. We measured absolute and relative inequality to assess gaps by wealth quintile. Pearson’s correlation coefficient was used to test the association between the coverage gap and population attributable risk.ResultsThe Composite Coverage Index showed patterns of inequality favoring the wealthiest subgroups. In eight countries the national coverage was higher than the global median (78.4%; 95% CI: 73.1–83.6) and increased significantly as inequality decreased (Pearson r = 0.9; p < 0.01).ConclusionsThere are substantial inequalities between socioeconomic groups. Reducing inequalities will improve coverage indicators for women and children. Additional health policies, programs, and practices are required to promote equity.

Crowdfunding and global health disparities: an exploratory conceptual and empirical analysis

BackgroundThe use of crowdfunding platforms to cover the costs of healthcare is growing rapidly within low-, middle-, and high-income countries as a new funding modality in global health. The popularity of such “medical crowdfunding” is fueled by health disparities and gaps in health coverage and social safety-net systems. Crowdfunding in its current manifestations can be seen as an antithesis to universal health coverage. But research on medical crowdfunding, particularly in global health contexts, has been sparse, and accessing robust data is difficult. To map and document how medical crowdfunding is shaped by, and shapes, health disparities, this article offers an exploratory conceptual and empirical analysis of medical crowdfunding platforms and practices around the world. Data are drawn from a mixed-methods analysis of medical crowdfunding campaigns, as well as an ongoing ethnographic study of crowdfunding platforms and the people who use them.ResultsDrawing on empirical data and case examples, this article describes three main ways that crowdfunding is impacting health equity and health politics around the world: 1) as a technological determinant of health, wherein data ownership, algorithms and platform politics influence health inequities; 2) as a commercial determinant of health, wherein corporate influence reshapes healthcare markets and health data; 3) and as a determinant of health politics, affecting how citizens view health rights and the future of health coverage.ConclusionsRather than viewing crowdfunding as a social media fad or a purely beneficial technology, researchers and publics must recognize it as a complex innovation that is reshaping health systems, influencing health disparities, and shifting political norms, even as it introduces new ways of connecting and caring for those in the midst of health crises. More analysis, and better access to data, is needed to inform policy and address crowdfunding as a source of health disparities.

Precarious Positions: Policy Options to Mitigate Risks in Non-Standard Employment

With the potential of precarious work to limit consumer willingness to spend, delay family formation and create too much uncertainty in the labour force, governments are paying close attention to these issues in Canada and abroad. Further, they are looking at a number of tools to address these issues, including changes to labour legislation and improvements in safety nets. But how widespread are employment risks and insecurities, and is it getting worse over time? In this Commentary, we look at the common meanings of precarious work in academic and policy research finding that various meanings help bring attention to employment arrangements with elevated insecurity. We examine trends in non-standard work in Canada and find that the overall prevalence of non-standard work has stabilized over the last couple of decades after growing sharply in the early 1990s. Non-standard work tends to be more insecure than “traditional” jobs, so its persistence over time and, in particular, increases in the prevalence of temporary employment – with large concentrations in health, education, and food services sectors, among others – prompts a deeper investigation. Many forces contribute to the creation of non-standard work. They include factors such as business desires for flexibility – often associated with globalization and technological change – but also worker preferences, which play a major role. In our view, the complexity behind causes of non-standard job creation, and the lessons from some international attempts to address specific areas of concerns through blunt legislative tools, militates in favour of looking to options that bolster the safety net. We think that although reviews of labour laws and their enforcement may lead to constructive discussions and new ideas to improve enforcement, interventions to shape employment arrangements with legislation pose the greatest risks of stymying job creation. In this Commentary, we present a list of options to reduce the income-related vulnerabilities and uncertainties faced by many non-standard workers. These include reducing gaps in health coverage, improving Employment Insurance (EI) eligibility, boosting access to social programs, and ensuring uptake of programs that improve access to education and skills training programs for workers. All of these options should help policymakers design the social safety net in ways that mitigates common risks in non-standard work, while supporting labour market dynamism.

262 BURDEN OF CHRONIC TRANSFUSION FOR MDS PATIENTS IN AN AMBULATORY SETTING

There is a limited understanding of preferences for micro health insurance (MHI) as a strategy for moving towards universal health coverage. Using a discrete choice experiment (DCE), we explored community preferences for the attributes and attribute-levels of a prospective MHI scheme, aimed at filling health coverage gaps in Malawi. Through a qualitative study informed by a literature review, we identified six MHI attributes (and attribute-levels): unit of enrollment, management structure, health service benefit package, copayment levels, transportation coverage, and monthly premium per person. Qualitative data was collected from 12 focus group discussions and 8 interviews in August–September, 2012. We constructed a D-efficient design of eighteen choice-sets, each comprising two MHI choice alternatives and an opt-out. Using pictorial images, trained interviewers administered the DCE in March–May, 2013, to 814 household heads and/or their spouse(s) in two rural districts. We estimated preferences for attribute-levels and relative importance of attributes using conditional and nested logit models. The results showed that all attribute-levels except management by external NGO significantly influenced respondents' choice behavior (P < 0.05). These included: enrollment as core nuclear family (odds ratio (OR) = 1.1574), extended family (OR = 1.1132), compared to individual; management by community committee (OR = 0.9494) compared to local micro finance institution; comprehensive health service package (OR = 1.4621), medium service package (OR = 1.2761), compared to basic service package; no copayment (OR = 1.1347), 25% copayment (OR = 1.1090), compared to 50% copayment; coverage of all transport (OR = 1.5841), referral and emergency transport (OR = 1.2610), compared to no transport; and premium (OR = 0.9994). The relative importance of attributes is ordered as: transport, health services benefits, enrollment unit, premium, copayment, and management. To maximize consumer utility and encourage community acceptance of MHI, potential MHI schemes should cover transport costs, offer a comprehensive benefit package, define the core family as the unit of enrollment, avoid high copayments, and be managed by a competent financial institution.

Challenges facing the United States of America in implementing universal coverage.

In 2010, immediately before the United States of America (USA) implemented key features of the Affordable Care Act (ACA), 18% of its residents younger than 65 years lacked health insurance. In the USA, gaps in health coverage and unhealthy lifestyles contribute to outcomes that often compare unfavourably with those observed in other high-income countries. By March 2014, the ACA had substantially changed health coverage in the USA but most of its main features – health insurance exchanges, Medicaid expansion, development of accountable care organizations and further oversight of insurance companies – remain works in progress. The ACA did not introduce the stringent spending controls found in many European health systems. It also explicitly prohibits the creation of institutes – for the assessment of the cost–effectiveness of pharmaceuticals, health services and technologies – comparable to the National Institute for Health and Care Excellence in the United Kingdom of Great Britain and Northern Ireland, the Haute Autorité de Santé in France or the Pharmaceutical Benefits Advisory Committee in Australia. The ACA was – and remains – weakened by a lack of cross-party political consensus. The ACA’s performance and its resulting acceptability to the general public will be critical to the Act’s future.

Eliciting community preferences for complementary micro health insurance: A discrete choice experiment in rural Malawi

There is a limited understanding of preferences for micro health insurance (MHI) as a strategy for moving towards universal health coverage. Using a discrete choice experiment (DCE), we explored community preferences for the attributes and attribute-levels of a prospective MHI scheme, aimed at filling health coverage gaps in Malawi. Through a qualitative study informed by a literature review, we identified six MHI attributes (and attribute-levels): unit of enrollment, management structure, health service benefit package, copayment levels, transportation coverage, and monthly premium per person. Qualitative data was collected from 12 focus group discussions and 8 interviews in August–September, 2012. We constructed a D-efficient design of eighteen choice-sets, each comprising two MHI choice alternatives and an opt-out. Using pictorial images, trained interviewers administered the DCE in March–May, 2013, to 814 household heads and/or their spouse(s) in two rural districts. We estimated preferences for attribute-levels and relative importance of attributes using conditional and nested logit models. The results showed that all attribute-levels except management by external NGO significantly influenced respondents' choice behavior (P < 0.05). These included: enrollment as core nuclear family (odds ratio (OR) = 1.1574), extended family (OR = 1.1132), compared to individual; management by community committee (OR = 0.9494) compared to local micro finance institution; comprehensive health service package (OR = 1.4621), medium service package (OR = 1.2761), compared to basic service package; no copayment (OR = 1.1347), 25% copayment (OR = 1.1090), compared to 50% copayment; coverage of all transport (OR = 1.5841), referral and emergency transport (OR = 1.2610), compared to no transport; and premium (OR = 0.9994). The relative importance of attributes is ordered as: transport, health services benefits, enrollment unit, premium, copayment, and management. To maximize consumer utility and encourage community acceptance of MHI, potential MHI schemes should cover transport costs, offer a comprehensive benefit package, define the core family as the unit of enrollment, avoid high copayments, and be managed by a competent financial institution.

Health Care as Commons: An Indigenous Approach to Universal Health Coverage

Modern health care systems of today are predominantly derived from Western models and are either state owned or under private ownership. Government, through their health policies, generally aim to facilitate access for the majority of the population through the design of their health systems. However, there are communities, such as Indigenous peoples, who do not necessarily fall under the formal protection of state systems. Throughout history, these societies have developed different ways to provide health care to its population. These health care systems are held and managed under different property regimes with their attendant advantages and disadvantages. This article investigates the gaps in health coverage among Indigenous peoples using the Malaysian Indigenous peoples as a case study. It conceptually examines a commons approach to health care systems through a study of the traditional health care system of indigenous peoples and suggests how such an approach can help close this gap in the remaining gaps of universal health coverage.

P-128 Myelodysplastic syndrome in Chile: Risk stratification and overall survival according to IPSS-R

There is a limited understanding of preferences for micro health insurance (MHI) as a strategy for moving towards universal health coverage. Using a discrete choice experiment (DCE), we explored community preferences for the attributes and attribute-levels of a prospective MHI scheme, aimed at filling health coverage gaps in Malawi. Through a qualitative study informed by a literature review, we identified six MHI attributes (and attribute-levels): unit of enrollment, management structure, health service benefit package, copayment levels, transportation coverage, and monthly premium per person. Qualitative data was collected from 12 focus group discussions and 8 interviews in August–September, 2012. We constructed a D-efficient design of eighteen choice-sets, each comprising two MHI choice alternatives and an opt-out. Using pictorial images, trained interviewers administered the DCE in March–May, 2013, to 814 household heads and/or their spouse(s) in two rural districts. We estimated preferences for attribute-levels and relative importance of attributes using conditional and nested logit models. The results showed that all attribute-levels except management by external NGO significantly influenced respondents' choice behavior (P < 0.05). These included: enrollment as core nuclear family (odds ratio (OR) = 1.1574), extended family (OR = 1.1132), compared to individual; management by community committee (OR = 0.9494) compared to local micro finance institution; comprehensive health service package (OR = 1.4621), medium service package (OR = 1.2761), compared to basic service package; no copayment (OR = 1.1347), 25% copayment (OR = 1.1090), compared to 50% copayment; coverage of all transport (OR = 1.5841), referral and emergency transport (OR = 1.2610), compared to no transport; and premium (OR = 0.9994). The relative importance of attributes is ordered as: transport, health services benefits, enrollment unit, premium, copayment, and management. To maximize consumer utility and encourage community acceptance of MHI, potential MHI schemes should cover transport costs, offer a comprehensive benefit package, define the core family as the unit of enrollment, avoid high copayments, and be managed by a competent financial institution.

State-to-State Variability in Title V Coverage for Children with Diabetes

Title V programs are federally supported safety nets for children with chronic diseases. However, using the example of children with diabetes mellitus, Title V program eligibility and scope of coverage vary by state and may result in health coverage gaps for high-risk patients.

The Promise of Affordable Care: Maintaining Coverage During Life Transitions

THE CALIFORNIA Journal of Politics & Policy Volume 3, Issue 4 The Promise of Affordable Care: Maintaining Coverage During Life Transitions Ann O’Leary Center for the Next Generation Elizabeth A. Capell, Ken Jacobs, Laurel Lucia University of California, Berkeley Abstract Americans’ health insurance coverage is not static; people cycle in and out of cov- erage and between sources of coverage during life transitions like losing a job, changing jobs, moving, or divorce. The Affordable Care Act creates an unprece- dented opportunity to address the gaps in health coverage caused by life transitions. Achieving the promise of the Affordable Care Act will require attention in federal regulations and actions by the new health insurance exchanges to ensure seamless coverage for those who rely on private insurance, including job-based coverage. This paper analyzes the population experiencing life transitions that lead to a loss of health coverage and makes several policy recommendations to ensure that all Americans can maintain health coverage under the ACA—even during compli- cated life transitions. Keywords: Affordable Care Act, health policy, Medicare, Medicaid, health insur- ance Copyright © 2011 The Berkeley Electronic Press. All rights reserved. www.bepress.com/cjpp

10+2 Agenda for Public Health in Nepal

Public health has come a long way in Nepal, but there is still a long way to go. Over the past years some remarkable achievements have been made in millennium development goals, such as reduction of child mortality, maternal mortality and fertility. However, there still exist wide gaps in health coverage among different ethnic groups, geographic regions and gender. In this context, a 10+2 agenda is recommended for scaling-up essential health care in Nepal. These focus on equity, tackling malnutrition, prioritizing non-communicable diseases, preventing accidents, injuries and disabilities, promoting environmental health, harnessing the power of education and communication for behavior change, strengthening health systems, fostering public-private partnership, capitalizing on international health partnerships, as well as institutionalizing a culture of non-violence, and consolidating genuine democracy.

The painful face of poverty

The painful face of poverty

Renal toxicity associated with zoledronic acid and pamidronate in multiple myeloma patients: A retrospective study

17515 Background: Patients (pts) with multiple myeloma (MM) are at an increased risk of renal impairment as part of disease progression. Herein we compared rates of renal toxicity in MM pts treated with zoledronic acid (ZO), pamidronate (PA), and no bisphosphonate (BP) treatment (NT). Methods: Medical and pharmacy claims and laboratory data were reviewed from &gt;35 managed care plans between 01/2000 and 12/2004. Inclusion criteria were ≥2 claims for MM, no gap in health coverage, and serum creatinine readings before and after first ZO or PA infusion. MM pts who received NT served as a separate reference group. Observation periods extended from initial BP infusion to health plan disenrollment (BP monotherapy) or BP switch. Renal impairment was defined as a ≥25% decrease in glomerular filtration rate (GFR,abbreviated MDRD formula) from baseline. Andersen-Gill model, adjusted for demographics and baseline comorbidities, was used to analyze multiple events in a given pt, as physician practice patterns indicate that administration of both BPs continues even after the development of a first renal event. Results: The study population comprised 122 ZO-treated pts, 90 PA-treated pts, and 213 NT pts. Baseline characteristics of ZO and PA groups were similar except the ZO group had a significantly better baseline GFR and higher previous nephrotoxic drug use (both p &lt; 0.01). After treatment, ZO and PA groups had similar renal impairment rates that were significantly higher than the NT group and increased with treatment duration (ZO 21.7%, PA 22.9%, NT 17.0% in pts treated for &lt;6 months; increasing to ZO 53.8%, PA 50.0%, NT 33.7% in pts treated for ≥18 months). Mean renal impairment events per person-year were significantly higher for ZO than PA (1.83 vs 0.78, p &lt; 0.001). Multiple-event analysis found a 2.6 times risk of renal impairment for ZO than PA (p &lt; 0.0001). Compared with PA, ZO-treated pts had a steeper decrease in mean GFR from baseline by 8.5% (p = 0.03). Conclusions: This retrospective observational study suggests that in MM patients, both ZO and PA are associated with a similar higher risk of renal impairment than NT, but ZO-treated pts are significantly more likely to experience multiple impairment events upon repeated administrations. [Table: see text]

Gaps in health coverage among working-age Americans and the consequences.

This paper examines health coverage and access to care among working-age adults using the Kaiser/Commonwealth 1997 National Survey of Health Insurance. One in three (52 million) working-age adults were either uninsured at the time of the survey or had a recent gap in their health coverage in the past two years. Having even a temporary gap in health coverage made a significant difference in access to care. Compared to the elderly, who are continuously covered by Medicare, working-age adults have greater problems paying their medical bills and gaining access to care and are less satisfied with their health insurance coverage.