Influence Of Health Insurance Research Articles

Influence of health insurance on withdrawal of life sustaining treatment for patients with isolated traumatic brain injury: a retrospective multi-center observational cohort study

BackgroundHealthcare inequities for patients with traumatic brain injury (TBI) represent a major priority area for trauma quality improvement. We hypothesized a relationship between health insurance status and timing of withdrawal of life sustaining treatment (WLST) for adults with severe TBI.MethodsThis multicenter retrospective observational cohort study utilized data collected between 2017 and 2020. We identified adult (age ≥ 16) patients with isolated severe TBI admitted participating Trauma Quality Improvement Program centers. We determined the relationship between insurance status (public, private, and uninsured) and the timing of WLST using a competing risk survival analysis framework adjusting for baseline, clinical, injury and trauma center characteristics. Multivariable cause-specific Cox regressions were used to compute adjusted hazard ratios (HR) reflecting timing of WLST, accounting for mortality events. We also quantified the between-center residual variability in WLST using the median odds ratio (MOR) and measured insurance status association with access to rehabilitation at discharge.ResultsWe identified 42,111 adults with isolated severe TBI treated across 509 trauma centers across North America. There were 10,771 (25.6%) WLST events in the cohort and a higher unadjusted incidence of WLST events was evident in public insurance patients compared to private or uninsured groups. After adjustment, WLST occurred earlier for publicly insured (HR 1.07, 95% CI 1.02–1.12) and uninsured patients (HR 1.29, 95% CI 1.18–1.41) compared to privately insured patients. Access to rehabilitation was lower for both publicly insured and uninsured patients compared to patients with private insurance. Accounting for case-mix, the MOR was 1.49 (95% CI 1.43–1.55), reflecting significant residual between-center variation in WLST decision-making.ConclusionsOur findings highlight the presence of disparate WLST practices independently associated with health insurance status. Additionally, these results emphasize between-center variability in WLST, persisting despite adjustments for measurable patient and trauma center characteristics.

The influence of health insurance on coverage of a country’s population with medical services

One of the effective ways to increase the level of population coverage with medical services is health insurance. The paper aims to determine what type of health insurance (compulsory, social, or voluntary) has the greatest impact on a country’s ability to provide large-scale and timely medical services to citizens, as measured by the number of unmet needs for medical examination, treatable and preventable mortality. The control variables included a country’s population size, the level of economic well-being, and the scale of the public health system (number of doctors and hospital beds) based on EUROSTAT data for all 27 EU countries in 2012–2021. Modelling (regression models of panel data with fixed and random effects in STATA 18, Wald test, Hausman test, Breusch and Pagan test) proved that only one of three researched types of insurance – voluntary health insurance – positively influences a country’s ability to provide large-scale and timely medical services to citizens: an increase in its volume by 1% leads to a decrease in unmet needs in medical examination on average across all EU countries by 0.26%, treatable mortality rate by 0.08%, preventive mortality rate by 0.27%. The influence of the other two types – compulsory and social – was not confirmed (received regression coefficients for these variables are not statistically significant). This emphasizes the importance of citizens’ conscious attitude to their health (due to the increase in voluntary health insurance) both in strengthening public health and in ensuring faster and better access to medical services.

Exploring health insurance and knowledge of the ovulatory cycle: evidence from Demographic and Health Surveys of 29 countries in Sub-Saharan Africa

BackgroundUnplanned pregnancy continues to be a major public health concern in Sub-Saharan Africa (SSA). Understanding the ovulatory cycle can help women avoid unplanned pregnancy. Though a wide range of factors for ovulatory cycle knowledge in SSA countries has not been well assessed, the influence of health insurance on ovulatory cycle knowledge is largely unknown. As a result, we set out to investigate the relationship between health insurance enrollment and knowledge of the ovulatory cycle among women of childbearing age. This study aims to investigate the relationship between health insurance enrollment and knowledge of the ovulatory cycle among women of childbearing age in sub-Saharan Africa (SSA).MethodsDemographic and Health Surveys (DHSs) data from 29 SSA countries were analyzed. The association between health insurance and ovulatory cycle knowledge was investigated using bivariate and multivariate multilevel logistic regression models among 372,692 women of reproductive age (15–49). The findings were presented as adjusted odds ratios (AOR) with 95% confidence intervals (CI). A p-value of 0.05 was considered statistically significant.ResultsThe pooled result shows that the prevalence of knowledge of ovulatory cycle in the studied 29 SSA countries was 25.5% (95% CI; 24.4%-26.6%). Findings suggest higher odds of ovulatory cycle knowledge among women covered by health insurance (AOR = 1.27, 95% CI; 1.02–1.57), with higher education (higher-AOR = 2.83, 95% CI; 1.95–4.09), from the richest wealth quintile (richest-AOR = 1.39, 95% CI; 1.04–1.87), and from female headed households (AOR = 1.16, 95% CI; 1.01–1.33) compared to women who had no formal education, were from the poorest wealth quintile and belonged to male headed households, respectively. We found lower odds of ovulatory cycle knowledge among women who had 2–4 parity history (AOR = 0.80, 95% CI; 0.65–0.99) compared to those with history of one parity.ConclusionsThe findings indicate that the knowledge of the ovulatory cycle is lacking in SSA. Improving health insurance enrollment should be considered to increase ovulatory cycle knowledge as an approach to reduce the region's unplanned pregnancy rate. Strategies for improving opportunities that contribute to women’s empowerment and autonomy as well as sexual and reproductive health approaches targeting women who are in poorest quintiles, not formally educated, belonging to male headed households, and having high parity should be considered.

The impact of health insurance on households’ financial choices: Evidence from Vietnam

This paper investigates the impact of health insurance on families' financial service choices in Vietnam using TVSEP data from three waves in 2013, 2016, and 2017. The endogeneity is handled via a recursive multivariate probit model. The findings indicate that while health insurance has no effect on private health insurance, it has a positive effect on savings and investments and a negative effect on credit choice. The multivariate probit model's results are robust to both the instrumental variable two-stage least squares model and the bivariate probit model. In addition, correlations between error components in financial service choice equations indicate a possible pattern of household financial usage. The results suggest that health insurance improves households' financial well-being. The implication of the findings is that when developing social security policies aimed at achieving universal health insurance, the influence of health insurance on household finances should not be underestimated.

Reproductive health vs overall well-being: systematic review of studies on women migration and health care utilization

Purpose Sustainable development goals (SDGs) recognize the importance and interrelation between health and migration. Women migration and health is well researched, yet less attention is paid to their healthcare utilization, especially with regard to overall health and well-being. This paper aims to highlight the gap in the existing literature on health care utilization by women migrants. Design/methodology/approach A systematic review was carried out following the PRISMA guideline. For the review, the literature was taken from three electronic databases, which were Springer Link, Taylor and Francis and PubMed. From a total of 1,575 studies, seven studies cleared the eligibility screening. Findings Of seven studies, five were found to focus on the sexual and reproductive health of the women migrants than their general health and well-being, and less attention is paid to health promotion and illness prevention beyond reproductive and sexual health. While, studies on general health have focused on the influence of health status on health care utilization and the influence of health insurance in health care utilization. The review has revealed the disparities faced by migrant women in different countries while seeking health care. Originality/value Studies on women migration and health care utilization have largely focused on the reproductive and sexual health needs of women, and this overemphasis often undermines their accessibility and affordability to overall health and well-being. Therefore, the present study has moved away from the concept of sexual and reproductive health tot that of overall health and well-being of women migrants.

Health Insurance Expansion and Incidence of Out-of-Hospital Cardiac Arrest: A Pilot Study in a US Metropolitan Community.

BackgroundHealth insurance has many benefits including improved financial security, greater access to preventive care, and better self‐perceived health. However, the influence of health insurance on major health outcomes is unclear. Sudden cardiac arrest prevention represents one of the major potential benefits from health insurance, given the large impact of sudden cardiac arrest on premature death and its potential sensitivity to preventive care.Methods and ResultsWe conducted a pre–post study with control group examining out‐of‐hospital cardiac arrest (OHCA) among adult residents of Multnomah County, Oregon (2015 adult population 636 000). Two time periods surrounding implementation of the Affordable Care Act were evaluated: 2011–2012 (“pre‐expansion”) and 2014–2015 (“postexpansion”). The change in OHCA incidence for the middle‐aged population (45–64 years old) exposed to insurance expansion was compared with the elderly population (age ≥65 years old) with constant near‐universal coverage. Rates of OHCA among middle‐aged individuals decreased from 102 per 100 000 (95% CI: 92–113 per 100 000) to 85 per 100 000 (95% CI: 76–94 per 100 000), P value 0.01. The elderly population experienced no change in OHCA incidence, with rates of 275 per 100 000 (95% CI: 250–300 per 100 000) and 269 per 100 000 (95% CI: 245–292 per 100 000), P value 0.70.ConclusionsHealth insurance expansion was associated with a significant reduction in OHCA incidence. Based on this pilot study, further investigation in larger populations is warranted and feasible.

The Influence of Health Insurance on Patient’s Health Treatment Seeking Behavior—The Case of Rural China

This paper assesses the effect of the New Rural Cooperative Medical Scheme (NRCMS) on rural patients’ health treatment seeking behavior in view of health care demand. Using data from 2004, 2006 and 2009 waves of China Health and Nutrition Survey (CHNS), the paper estimates the effect of health insurance based on the method of Multinomial Logit Model. The result shows that enrollment in NRCMS significantly improves the utilization of formal medical service. Furthermore, we find that age plays significantly negative role in choosing formal heath service and gender has nothing to do with the choice of health treatment. High income significantly increases the utilization of private medical service. The severity of disease and chronic disease are significant factors in choosing formal medical service. While the NRCMS coverage is increasing, the insured are more likely to choose self-treatment.

Assessment of universal health coverage for adults aged 50 years or older with chronic illness in six middle-income countries.

ObjectiveTo assess universal health coverage for adults aged 50 years or older with chronic illness in China, Ghana, India, Mexico, the Russian Federation and South Africa.MethodsWe obtained data on 16 631 participants aged 50 years or older who had at least one diagnosed chronic condition from the World Health Organization Study on Global Ageing and Adult Health. Access to basic chronic care and financial hardship were assessed and the influence of health insurance and rural or urban residence was determined by logistic regression analysis.FindingsThe weighted proportion of participants with access to basic chronic care ranged from 20.6% in Mexico to 47.6% in South Africa. Access rates were unequally distributed and disadvantaged poor people, except in South Africa where primary health care is free to all. Rural residence did not affect access. The proportion with catastrophic out-of-pocket expenditure for the last outpatient visit ranged from 14.5% in China to 54.8% in Ghana. Financial hardship was more common among the poor in most countries but affected all income groups. Health insurance generally increased access to care but gave insufficient protection against financial hardship.ConclusionNo country provided access to basic chronic care for more than half of the participants with chronic illness. The poor were less likely to receive care and more likely to face financial hardship in most countries. However, inequity of access was not fully determined by the level of economic development or insurance coverage. Future health reforms should aim to improve service quality and increase democratic oversight of health care.

Influence of Health Insurance on Rational Use of Drugs

AIM: In 2005, Nigeria introduced the Formal Sector Social Health Insurance component of National Health Insurance Scheme. This provides public sector workers with a package of health interventions in return for employee and or employers contributions to the scheme. For the military, the entire contribution is paid by the government. Before health insurance was introduced, the prescription pattern at a Nigerian military hospital was reported as irrational with high drugs per encounter, low use of generic prescriptions and high level of injection use. The aim of this study is to evaluate how health insurance affects the rational use of drugs in the same facility using World Health Organisation criteria. METHOD: Retrospective cross-sectional study of case notes of patients seen at the general out-patients clinics of Military Hospital, Ikoyi, Lagos Nigeria between 2008 and 2011. Data collection from 180 case notes sampled through stratified sampling technique to retrieve 45 case notes per year. Materials were collected to calculate prescribing indicators as stipulated by the WHO. RESULTS: From analysis of 180 case notes, patients were aged from 1 week to 66years (mean 24.09±17.02). More patients were below 10years (28.3%) and 30-39 years (27.8%). The overall male to female ratio was 1.15:1. There were 446 drugs prescribed for 160 patients. The average drug encounter rate was 2.6, the generic prescription rate was 56.4%, antibiotic encounter rate was 35.0% while the injection prescription rate was 8.9%. Out of 50 questionnaires in the qualitative study, 29 doctors, 16 pharmacists returned theirs. Doctors (82.8%) and pharmacists (75.0%) were interested in mode of patient payment for prescription medicines. For patients who pay out-of-pocket, while doctors favoured using generic and branded drugs (44.8%), generics (37.9%); pharmacists favoured generic and branded drugs (81.3%) and generics (19.7%) with slight statistical difference (p=0.04) between both professionals. CONCLUSION: The change in payment pattern from out-of-pocket to health insurance has actually reduced average drug prescribed per encounter, increased prescription of generics possibly because hospital reimbursement is at the rate of generics and based on capitation for these group of patients. There was scant moral hazard in the slight increase in antibiotic prescription possibly due to improved affordability under health insurance. Nigerian health insurance agencies need to pursue enlightenment of stake holders on rational drugs use, while government needs to increase the covered population to optimize benefits accruable from health insurance

Influence of health insurance, hospital factors and physician volume on receipt of immediate post-mastectomy reconstruction in women with invasive and non-invasive breast cancer

For women with breast cancer who undergo mastectomy, immediate breast reconstruction (IR) offers a cosmetic and psychological advantage. We evaluated the association between demographic, hospital, surgeon and insurance factors and receipt of IR. We conducted a retrospective hospital-based analysis with the Perspective database. Women who underwent a mastectomy for invasive breast cancer (IBC) and ductal carcinoma in situ (DCIS) from 2000 to 2010 were included. Logistic regression analysis was used to determine factors predictive of IR. Analyses were stratified by age (<50 vs. ≥ 50) and IBC versus DCIS. Of the 108,992 women with IBC who underwent mastectomy, 30,859 (28.3 %) underwent IR, as compared to 6,501 (44.2 %) of the 14,710 women with DCIS who underwent mastectomy underwent IR. In a multivariable model for IBC, increasing age, black race, being married, rural location, and increased comorbidities were associated with decreased IR. Odds ratios (OR) of IR increased with commercial insurance (OR 3.38) and Medicare (OR 1.66) insurance (vs. self-pay), high surgeon-volume (OR 1.19), high hospital-volume (OR 2.24), and large hospital size (OR 1.20). The results were identical for DCIS, and by age category. The absolute difference between the proportion of patients who received IR with commercial insurance compared to other insurance, increased over time. Immediate in-hospital complication rates were higher for flap reconstruction compared to implant or no reconstruction (15.2, 4.0, and 6.1 %, respectively, P < .0001). IR has increased significantly over time; however, modifiable factors such as insurance status, hospital size, hospital location, and physician volume strongly predict IR. Public policy should ensure that access to reconstructive surgery is universally available.

The influence of health insurance towards accessing essential medicines: The experience from Shenzhen labor health insurance

Due to major problems of accessing essential medicines, this paper will evaluate the impact of the new Shenzhen labor health insurance on accessing essential medicines among migrant workers. Medicines data and revenues-expenditures reports from 19 community health service centers in Shenzhen city were collected. Insurance indicators within two periods before and after 1st June 2006 were compared. Paired t-tests using month-values of indicators were performed. P value<0.05 considered statistically significant. The proportion of EMs in Medicine List of Shenzhen Labor health insurance is 88.5%. For each period, percentage costs of EM procured (Peem) was 43.1% and increased to 46.1%; costs of medicines per outpatient visit (Empv) was 24.94 RMB and decreased to 22.20 RMB; percentage costs of medicine per outpatient visit (Pe) were 49.1% and decreased to 45.9%; number of outpatient visits (Nov) was 428,328 and increased to 490,305. Values of t for differences in Peem, Empv, Pe and Nov between the two periods were -1.125 (P=0.285), 3.096 (P=0.010), 1.458 (P=0.173) and -2.069 (P=0.063), respectively. Shenzhen labor health insurance had improved accessibility to EMs for migrant workers, and ensured for them basic health services. Popularization of this insurance will benefit more people.

The influence of health insurance on hospital admission and length of stay—The case of Vietnam

Few studies analyze the effects of health insurance on inpatient care in low income countries. This paper provides an empirical assessment of the influence of Vietnam's health insurance schemes on both hospital admission and the length of stay (LOS) using the Vietnam National Health Survey 2001–2002 and an appropriate count data regression model. Our findings suggest that the influence of health insurance on hospital admission and the LOS varies across insurance schemes. The compulsory insurance scheme and the insurance scheme for the poor increase the expected LOS by factors of 1.18 and 1.39, respectively, while the voluntary insurance scheme has minimal effect on the expected LOS. Insurance also increases the likelihood of hospital admission far more for compulsory members than for members of the other two insurance schemes. The positive influence of insurance on hospital admission and the LOS also varies across income quintiles, regions and types of health facilities. While the compulsory and voluntary schemes increase the likelihood of hospital admission more for lower and middle income individuals, the influence of the compulsory scheme on the expected LOS is more pronounced for patients in the middle income groups. The influence of insurance on the LOS is also found to be stronger in the North than in the South and stronger for patients admitted to provincial hospitals rather than district hospitals.

Health care triage alternatives and the influence of health insurance, education and race

The relationship between one of Andersen's enabling factors, health insurance status and the choice of a pharmacist as the initial contact in the health care system was examined via telephone surveys. Eighty-seven percent of the sample reported having some form of health insurance. Of all intended health care provider contacts, pharmacists were selected as the initial contact 21% of the time. Logistic regression identified insurance status, education and race as significant (alpha < 0.05) covariates in the model. The odds ratios generated from the logit model indicated that non-whites, persons with less education and no health insurance were more likely to select a pharmacist for triage. The study concluded that uninsured persons were nearly twice as likely to seek pharmacist triage than insured individuals. Pharmacists may be filling an important triage gap for individuals who have limited financial access to traditional sources of physician care.