Low Health Insurance Research Articles

Blowin’ in the wind: Long-term downwind exposure to air pollution from power plants and adult mortality

We estimate the causal effects of long-term exposure to air pollution emitted from fossil fuel power plants on adult mortality. We leverage quasi-experimental variation in daily wind patterns, which is further instrumented by the county orientation from the nearest power plant. We find that the county’s fraction of days spent downwind of plants within 20 miles in the last 10 years is associated with increased mortality from COVID-19 through the third peak in mortality in January 2021. This effect is more pronounced in fenceline communities with high poverty rates, low health insurance coverage, and low educational attainment.

Detection and management of localized prostate cancer in Nigeria: barriers and facilitators according to patients, caregivers and healthcare providers

BackgroundProstate cancer mortality rates are high in Nigeria. While prostate cancer is highly curable with early detection and effective multidisciplinary management, the quality of care is suboptimal in this setting. Sustainable delivery of high-quality care for patients with localized prostate cancer is needed to save more lives. To inform future interventions to improve care, this study aimed to identify barriers and facilitators that influence prostate cancer detection and management in Nigeria.MethodsSix focus group discussions (FGDs), stratified by stakeholders were conducted with a purposive sample of prostate cancer patients (n = 19), caregivers (n = 15), and healthcare providers (n = 18), in two academic tertiary hospitals in northern and southern Nigeria. A discussion guide organized based on the socio-ecological model was used. FGDs were recorded, transcribed, and analysed using the framework technique.ResultsBarriers and facilitators were identified at the individual, interpersonal, and organizational levels. Barriers to detection included limited knowledge and misperceptions among patients, caregivers, and community-based non-specialist healthcare providers, and limitations of centralized opportunistic screening; while facilitators included the potential for religious institutions to encourage positive health-seeking behaviour. Barriers to management included non-uniformity in clinical guideline usage, treatment abandonment amidst concerns about treatment and survival, absence of patient interaction platforms and follow-up support systems, difficulty in navigating service areas, low health insurance coverage and limited financial resource of patients. Facilitators of management included the availability of resource stratified guidelines for prostate cancer management and the availability of patient peers, caregivers, nurses, and medical social workers to provide correct medical information and support patient-centred services. Participants also provided suggestions that could help improve prostate cancer detection and management in Nigeria.ConclusionThis study identified multiple determinants affecting the detection and management of localized prostate cancer. These findings will inform the refinement of implementation strategies to improve the quality of prostate cancer care in Nigeria.

Influence of Socioeconomic Status on Functional Outcomes After Stroke: A Systematic Review and Meta-Analysis.

This review aimed to quantify the impact of socioeconomic status on functional outcomes from stroke and identify the socioeconomic status indicators that exhibit the highest magnitude of association. We performed a systematic literature search across Medline and Embase from inception to May 2022, to identify observational studies (n≥100, and in English). Risk of bias was assessed using the modified Newcastle Ottawa Scale. Random effects meta-analysis was used to pool data. We included 19 studies (157 715 patients, 47.7% women) reporting functional outcomes measured with modified Rankin Scale or Barthel index, with 10 assessed as low risk of bias. Measures of socioeconomic status reported were education (11 studies), income (8), occupation (4), health insurance status (3), and neighborhood socioeconomic deprivation (3). Pooled data suggested that low socioeconomic status was significantly associated with poor functional outcomes, including incomplete education or below high school level versus high school attainment and above (odds ratio [OR], 1.66 [95% CI, 1.40-1.95]), lowest income versus highest income (OR, 1.36 [95% CI, 1.02-1.83]), a manual job/being unemployed versus a nonmanual job/working (OR, 1.62 [95% CI, 1.29-2.02]), and living in the most disadvantaged socioeconomic neighborhood versus the least disadvantaged (OR, 1.55 [95% CI, 1.25-1.92]). Low health insurance status was also associated with an increased risk of poor functional outcomes (OR, 1.32 [95% CI, 0.95-1.84]), although this was association was not statistically significant. Despite great strides in stroke treatment in the past decades, social disadvantage remains a risk factor for poor functional outcome after an acute stroke. Further research is needed to better understand causal mechanisms and disparities.

Strategies for increasing effective coverage of hypertension services in health care facilities: a scoping review

Purpose: To identify supporting and inhibiting factors for effective coverage of hypertension services, as well as recommendations for improvement efforts that can be made. Methods: A scoping review consists of five steps: Identification of research questions, identification of relevant research articles, study selection, data collection, and data synthesis. Results: 19 articles met the research objectives. Supporting factors include information systems, electronic-based pharmaceutical services, self-management, health insurance, quality improvement cycles, support for professionals, patients’ interventions, and digital technology. Inhibiting factors include low health insurance coverage, inaccurate equipment, inappropriate diagnosis and treatment, lack of screening coverage, difficulty in access, and differences in policies and procedures between regions. Recommendations for improvement include changes to service systems, the use of defined hypertension thresholds, ensuring blood pressure measurement devices are functioning properly, and the implementation of consistent policies, systems, and processes throughout the healthcare system, including between regions. Conclusion: There are various opportunities for improvement, both in utilizing existing supportive factors and reducing inhibiting factors, as well as in implementing various improvement recommendations, especially those that proved effective in published research.

Sociodemographic and Occupational Characteristics Associated with Early and Continued COVID-19 Vaccine Uptake Among Healthcare Personnel: Monroe County, NY

ObjectiveIdentify characteristics of healthcare personnel (HCP) who did not have timely initiation of the COVID-19 primary series, as well as HCP who did not receive a booster vaccine. MethodsCharacteristics of HCP enrolled in a COVID-19 vaccine effectiveness study between 12/28/2020–12/01/2022 were compared by timing of receipt of 1st mRNA dose, and by receipt of a booster dose. Data for this retrospective cohort analysis came from HCP working at a large healthcare system in Monroe County, New York, and included standardized questionnaires and verified vaccination status. HCP were categorized by whether they received their 1stmRNA COVID-19 vaccine between 12/14/2020–03/30/2021 (earlier) or 04/01/2021–09/28/2021 (later) based on timing of local vaccine eligibility and mandates, and by whether they received a 3rdmRNA booster dose by 12/01/22. Logistic regression models were run to identify characteristics of HCP who had later 1stdose receipt or did not receive a booster. Results3,375 HCP were enrolled. Of these, 86.8 % had early initiation of their 1stCOVID-19 vaccine, and 85.0 % received a booster dose. Low education, low household income, younger age (<50), non-White race and public health insurance were all significant predictors of later receipt of 1stdose and lack of uptake of a booster. However, advanced professional role was only found to be a significant predictor of early 1stdose receipt. ConclusionsContinual monitoring of COVID-19 vaccine uptake among HCP to identify those less likely to receive new booster doses will be crucial to support targeted vaccine campaigns in this important population.

Health insurance uptake, poverty and financial inclusion in the Democratic Republic of Congo

AbstractThis study estimates the prevalence of health insurance coverage and associated socioeconomic factors in the Democratic Republic of Congo (DRC). Using the nationally representative household survey of the 2017/2018 DRC Multiple Indicator Cluster Survey (MICS), we applied weighted logistic regression models to identify regions and subgroups with low health insurance coverage. The study's findings revealed a low insurance coverage of less than 5%, with significant disparities across provinces and socioeconomic status. Additionally, three factors were strongly associated with the low health insurance coverage rates: education, wealth, and financial inclusion proxied by bank account ownership. Consequently, we recommend that the government, the private sector, and donors prioritize programs targeting provinces with less coverage and individuals without formal education to increase health insurance coverage. This study encourages the government to establish national programs to improve financial inclusion, which could positively impact poverty reduction and health insurance coverage. We also propose that the government initiates pilot projects for premium exemptions and through subsidies for vulnerable populations in the short term, and ensure formal employment for the majority of the population in the long term to facilitate the proper collection of premiums for individuals. Overall, this study contributes to the literature on health insurance in the DRC and sub‐Saharan Africa by identifying the socioeconomic factors that explain the prevalence of health insurance coverage. The findings of this study have important policy implications for the government, the private sector, and donors to promote health insurance coverage and achieve universal health coverage.

Assessing the feasibility and preliminary effects of a health insurance navigation intervention for colorectal cancer survivors.

506 Background: Colorectal cancer survivors are at-risk for being underinsured and experiencing health insurance-related financial burden. Low health insurance literacy (HIL) reduces survivors’ ability to utilize health insurance. We conducted a pilot randomized controlled trial to assess the feasibility and preliminary effects of a virtually-delivered health insurance navigation tool (HINT) intervention to improve HIL and decrease financial burden among colorectal survivors. Methods: We tested a theoretically-driven 5-session intervention that included: 1) Learning About Survivorship Healthcare Needs; 2) Learning About Your Plan in Relation to Policy; 3) Navigating One’s Own Plan and Overcoming Obstacles; 4) Managing Care Costs; and 5) Understanding Your Medical Bills and Review. Eligibility included patients treated for colorectal cancer at Mass General Cancer Center, insured, and with access to wireless device. We assessed the feasibility and preliminary effects of HINT vs enhanced usual care (EUC; health insurance booklet) on HIL (assessing knowledge and confidence with health insurance terms and activity, knowledge of Affordable Care Act [ACA]), psychological financial burden (assessing worry due to medical costs), and satisfaction with health insurance coverage. Paired t-tests and cohen’s d were used to explore pre-post changes within the HINT and EUC groups from baseline (BL) to 5-month follow-up (FU). Results: From 1/22-2/23, we enrolled 34 participants (63% enrollment rate); 41.7% female; 88.2% white, Mean age=49.7 years. 82.7% of HINT participants completed all 5 intervention sessions. There were gaps in HIL (HIL mean 29.1, sd=7.9; 16-60 (high-low); 41.2% were not familiar with the ACA. 31/34 (91%) completed the 5-month follow-up survey. Among HINT participants, HINT significantly improved HIL and ACA knowledge; there was a non-significant trend toward reduced psychological financial burden and decreased health insurance satisfaction (see Table). Among EUC participants, there was a non-significant trend toward reduced psychological financial burden and no changes in any other variables. Clinical trial information: NCT05002608 .[Table: see text]

Family Support, Perceived Physical Activeness and Chronic Non-Communicable Diseases as Determinants of Formal Healthcare Utilization Among Older Adults with Low Income and Health Insurance Subscription in Ghana

ABSTRACT Evidence suggests that enrollment in a health insurance scheme is associated with higher levels of formal healthcare utilization among older adults, especially those with low income in sub-Saharan Africa (SSA), including Ghana. This study examines the prevalence of formal healthcare utilization and associated factors among older adults with low income and health insurance subscription enrolled in a social intervention program (known as the Livelihood Empowerment Against Poverty [LEAP] program) in Ghana. Cross-sectional data were obtained from an Aging, Health, Lifestyle and Health Services Survey conducted in 2018 among 200 older adults aged 65 years and above enrolled in the LEAP program. The results showed that almost 9 in 10 (87%) older adults utilized formal healthcare services for their health problems. Older adults who received family support, rated themselves to be physically active and had non-communicable diseases (NCDs) were more significantly likely to utilise formal health care services than their counter parts. We recommend that health policies and programs for older adults with low income and health insurance subscription under the LEAP program should consider the roles of family support, physical activeness and NCDs in influencing their use of formal healthcare services.

Effect of Adolescent Health Policies on Health Outcomes in India

Adolescence is a crucial phase marked by significant physical, psychological, emotional, and social changes. India has the world’s largest adolescent population. Understanding and addressing their health needs is vital for the nation’s social, political, and economic progress. The primary aim of this study was to evaluate the main adolescent health policies and strategies implemented from 2006 to 2020 and analyze the outcomes for adolescent health in India. To achieve this objective, the research adopted a mixed-method approach, combining qualitative and quantitative analyses of health policies, strategies, and programs implemented since 2005. Additionally, data from the most recent three Demographic Health Surveys (DHSs) were analyzed and compared to assess changes in adolescent health indicators after implementing these policies/strategies. The findings focused on India’s major adolescent health policies, namely the Adolescent Reproductive and Sexual Health (ARSH) Strategy2005, Rashtriya Kishor Swasthya Karyakram (RKSK) 2014, and the School Health Program 2020. All the strategies and programs aim to provide a comprehensive framework for sexual and reproductive health services, expand the scope of adolescent health programming, and address various health aspects. The analysis highlighted strengths in targeted interventions, monitoring, and promotion but weaknesses in awareness, societal barriers, and healthcare worker participation. Opportunities include female-friendly clinics and education about early pregnancy, while addressing substance abuse and training volunteers remain challenges. Family planning has improved with higher contraception usage and a decline in unmet needs. The incidence of violence decreased, and positive health behaviors increased, such as condom use. However, challenges remain, including limited access to health services, concerns about female providers, and low health insurance coverage. Nutrition indicators showed a slight increase in overweight/obesity and anemia rates. In conclusion, progress has been made, but certain adolescent health aspects still require attention. Further efforts are needed to achieve universal health coverage and improve adolescent health outcomes. Conducting targeted awareness campaigns, strengthening health worker and NGO engagement, and combating the increasing prevalence of overweight and obesity among adolescents are recommended.

Determinants of singleness among women aged 40 and over in Algeria: what relation to the labor market?

The decrease in the average age of marriage and the increase in loneliness among women in Algeria is a phenomenon that is becoming increasingly visible in society. In the coming years, the number of single people will increase. This article analyses the factors leading to increased loneliness among women aged 40 and over in Algeria based on data from the MICS6/2019 survey. The minimum age threshold was chosen because it corresponds to the age after which the probability of first marriage is almost zero based on Algerian statistics. The methodology of this study is stepwise Wald logistic regression. The paper built regression models based on two samples: the first (24,681 women aged 40 and over) and the second (4,329 women aged 50-54). For an empirical study of loneliness among women, it is proposed to analyze the following determinants: type of employment, type of social protection, place of residence, level of education, and age. Based on the results of the research, four main conclusions were formed. First, the odds of being single are 14.1 times and 4.23 times higher among job-seeking and working women, respectively, compared to non-working women. Due to the loss of hope to get married, women choose career development instead of building a family union. Under these conditions, women integrate into the labor market late. Since most of this category is unemployed and not of retirement age, they have low health insurance coverage. Based on this, to create decent living conditions for single women aged 40 and older, it is advisable to launch a program to improve the qualifications of these women, find ways to integrate them into the working environment and provide them with health insurance. Secondly, the long-term trend indicates that loneliness as a psychological phenomenon will increase every year in society, which will, accordingly, contribute to the strengthening of the imbalance in the marriage market. Late marriage and declining fertility are indicators of new patterns of behavior brought about by economic and social change. Thirdly, the level of well-being is also a statistically significant factor influencing the loneliness of women. Middle-class women are 1.27 times more likely to be single than upper-class women. Fourth, the survey revealed significant regional differences. Women in Algeria’s north-eastern and north-central regions are more likely to remain single. These results can be further explored through qualitative research.

Cost of Public Health Insurance for US-Born and Immigrant Adults

The immigrant population in the US has low health insurance coverage. Surveys find that approximately one-half of the US population is opposed to public health insurance of immigrants, and there is a widely held belief that immigrants are a state fiscal liability. To estimate the cost of providing public health insurance to immigrants in the US. This serial cross-sectional study used restricted data from the 2011 to 2019 Medical Expenditure Panel Survey (and data from 2011-2020 in supplemental analyses). The data are nationally representative of the US civilian noninstitutionalized population. Participants included adults aged 19 to 64 years with family incomes below 138% of the Federal Poverty Level, the population that benefited from the Medicaid expansions. Data analysis was performed from November 2022 to August 2023. State Medicaid expansion. The primary outcomes were insurance coverage, total health care expenditures, expenditures categorized by payment source (paid by self or family and paid by others), expenditures by major health care type (office based, inpatient, and prescription), and health care utilization (number of office-based visits, outpatient facility visits, emergency department visits, hospital discharges, dental care visits, home health clinician days, and prescription medicine refills). A difference-in-differences method was used to compare the health care cost and utilization by low-income, working-age US-born and immigrant adults in states that adopted the Patient Protection and Affordable Care Act (ACA) Medicaid expansions with the corresponding change in nonexpansion states before and after the policy implementation. Among the study sample of 44 482 individuals (mean [SD] age, 38.5 [14.0] years; 25 221 female individuals [56.7%]; 34 052 [76.6%] US born), 46% of immigrant adults (1953 participants) and 70% of US-born adults (9396 participants) had insurance coverage in the pre-ACA period. Medicaid expansions increased insurance coverage of both groups by 7 percentage points (95% CI, 3 to 11 percentage points). The resulting change in health care increased total expenditures (self-paid plus insurer paid) by $660 (95% CI, $79 to $1242) and insurer-paid expenditures by $745 (95% CI, $141 to $1350) per US-born adult. For immigrant adults, the corresponding changes in total ($266; 95% CI, -$348 to $880) and insurer-paid ($308; 95% CI, -$352 to $968) expenditures were small and not statistically significant. Estimates suggest that providing insurance to immigrants costs the health care system approximately $3800 per person per year, less than one-half the corresponding cost ($9428 per person per year) for US-born adults. These findings suggest that the direct cost of providing public health insurance to immigrants is less than that for the US born, and immigrants' health care utilization, upon coverage, remains comparatively modest, thus refuting the notion that providing insurance to immigrants imposes a heavy fiscal burden.

Uncovering heterogeneous cardiometabolic risk profiles in US adults: the role of social and behavioral determinants of health

IntroductionSocial and behavioral determinants of health (SBDH) have been linked to diabetes risk, but their role in explaining variations in cardiometabolic risk across race/ethnicity in US adults is unclear. This...

Examining the Effectiveness of Financial Protection Schemes in Reducing Health Inequality.

Health protection schemes such as health insurance and financial assistance provide immense help and support to access health care services, especially to the poor and marginalized section of society. India is witness to low health-related expenditure, and the society's socioeconomic and demographic structure further drops health care access to the new bottom. Consequently, inequality in health care access is highly observed across many socioeconomic attributes. The condition of Bihar, the poorest state of India, is more alarming. The analysis suggests that financial support in terms of universal health insurance coverage considerably reduces out-of-pocket expenditure and thus health inequality. Further, the low health insurance coverage is not solely due to a lack of institutional commitment and implementation process; the cognitive behavior and attitude of people are equally responsible for low health care access. An intensive awareness program to show the benefit of the health insurance scheme and sensitization of people against the social stigma is important to provide better health care access and reduce health inequality.

Association of food insecurity with reduced cancer screening rates.

e18609 Background: Social determinants of health, including access to adequate food and nutrition, may influence many aspects of healthcare, including cancer screening. This study explored the associations between food insecurity and cancer screening. Methods: A retrospective analysis was conducted using the National Health Interview Series from 2021 to capture contemporary events. Based on scaled questionnaires, food security was stratified into either food secure or insecure, and then subgrouped into high, marginal, or low security (i.e. most insecure). Associations were made with rates of having at least one screening test. Relationships between variables were evaluated using Chi-Square and Cochran-Armitage trend tests. Logistic regression models were used to find factors associated with cancer screening. Results: Patients included in analyses included: 19,916 for colon, 15,293 for cervical, and 8,589 for prostate cancer screening. Those with food insecurity had significantly lower rates of cancer screening than those with food security across all 3 cancer screens, including for colon (51.3% vs. 61.8% p &lt; 0.0001), cervical (78.1% vs. 85.2% p &lt; 0.0001), and prostate (36.0% vs. 51.5%, p &lt; 0.0001). This was similar when comparing low, marginal, and high food security, respectively, for colonoscopies (50.1% vs. 52.6% vs. 61.8%, p &lt; 0.0001), cervical cancer screening (78% vs. 78.2% vs. 85.1%; p &lt; 0.0001), and prostate-specific antigen testing (31.2% vs. 41.2% vs. 51.5%; p &lt; 0.0001). Other social determinants were analyzed, including insurance type (public vs. private), age, and race. Patients with public health insurance had lower screening rates across all three cancers compared to those with private insurance (p &lt; 0.0001). Lower food security was linked with younger age (p &lt; 0.0001), and Black patients were disproportionately affected by food insecurity compared to other races (p &lt; 0.001). Adjusted for covariates, low food security, minority racial groups, and public insurance were associated with lower odds of cancer screening. Conclusions: Individuals with self-reported food insecurity were found to have lower cancer screening rates than those who were food secure. Further analysis of demographic and clinical information revealed associations between low food security status and public health insurance, younger age, and Black race. These data suggested that measures can be taken to address food insecurity in these populations that appear to be most vulnerable to lacking appropriate cancer screening. [Table: see text]

Health Insurance and Mental Health Treatment Use Among Adults With Criminal Legal Involvement After Medicaid Expansion.

Individuals with criminal legal involvement have high rates of substance use and other mental disorders. Before implementation of the Affordable Care Act's Medicaid expansion, they also had low health insurance coverage. The objective of this study was to assess the impact of Medicaid expansion on health insurance coverage and use of treatment for substance use or other mental disorders in this population. The authors used restricted data (2010-2017) from the National Survey on Drug Use and Health (NSDUH). Using a difference-in-differences approach, the authors estimated the impact of Medicaid expansion on health insurance coverage and treatment for substance use or other mental disorders among individuals with recent criminal legal involvement. The sample consisted of 9,910 NSDUH respondents who were ages 18-64 years, had a household income ≤138% of the federal poverty level, and reported past-year criminal legal involvement. Medicaid expansion was associated with an 18 percentage-point increase in insurance coverage but no change in receipt of substance use treatment among individuals with substance use disorder. Individuals with any other mental illness had a 16 percentage-point increase in insurance coverage but no change in receipt of mental health treatment. Despite a large increase in health insurance coverage among individuals with criminal legal involvement and substance use or other mental disorders, Medicaid expansion was not associated with a significant change in treatment use for these conditions. Insurance access alone appears to be insufficient to increase treatment for substance use or other mental disorders in this population.

Equity in the public social healthcare protection in Tanzania: does it matter on household healthcare financing?

Efforts to promote equity in healthcare involve implementing policies and programs that address the root causes of healthcare disparities and promote equal access to care. One such program is the public social healthcare protection schemes. However, like many other developing countries, Tanzania has low health insurance coverage, hindering its efforts to achieve universal health coverage. This study examines the role of equity in public social healthcare protection and its effects on household healthcare financing in Tanzania. The study used secondary data collected from the National Bureau of Statistics' National Panel Survey 2020/21 and stratified households based on their place of residence (rural vs. urban). Moreover, the logit regression model, ordered logit, and the endogenous switching regression model were used to provide counterfactual estimates without selection bias and endogeneity problems. The results showed greater variations in social health protection across rural and urban households, increasing disparities in health outcomes between these areas. Rural residents are the most vulnerable groups. Furthermore, education, income, and direct healthcare costs significantly influence equity in healthcare financing and the ability of households to benefit from public social healthcare protection schemes. To achieve equity in healthcare in rural and urban areas, developing countries need to increase investment in health sector by reducing the cost of healthcare, which will significantly reduce household healthcare financing. Furthermore, the study recommends that social health protection is an essential strategy for improving fair access to quality healthcare by removing differences across households and promoting equality in utilizing healthcare services.

Cardiovascular Disease and Its Implication for Higher Catastrophic Health Expenditures Among Households in Sub-Saharan Africa.

Background: Cardiovascular diseases (CVDs) impose an enormous and growing economic burden on households in sub-Saharan Africa (SSA). Like many chronic health conditions, CVD predisposes families to catastrophic health expenditure (CHE), especially in SSA due to the low health insurance coverage. This study assessed the impact of CVD on the risks of incurring higher CHE among households in Ghana and South Africa. Methods: The World Health Organization (WHO) Study on Global AGEing and Adult Health (WHO SAGE), Wave 1, implemented 2007-2010, was utilized. Following standard procedure, CHE was defined as the health expenditure above 5%, 10%, and 25% of total household expenditure. Similarly, a 40% threshold was applied to household total nonfood expenditure, also referred to as the capacity to pay. To compare the difference in mean CHE by household CVD status and the predictors of CHE, Student's t-test and logistic regression were utilized. Results: The share of medical expenditure in total household spending was higher among households with CVD in Ghana and South Africa. Households with CVD were more likely to experience greater CHE across all the thresholds in Ghana. Households who reported having CVD were twice as likely to incur CHE at 5% threshold (odds ratio [OR], 1.946; confidence interval [CI], 0.965-1.095), 3 times as likely at 10% threshold (OR, 2.710; CI, 1.401-5.239), and 4 times more likely to experience CHE at both 25% and 40% thresholds, (OR, 3.696; CI, 0.956-14.286) and (OR, 4.107; CI, 1.908-8.841), respectively. In South Africa, households with CVD experienced higher CHE across all the thresholds examined compared with households without CVDs. However, only household CVD status, household health insurance status, and the presence of other disease conditions apart from CVD were associated with incurring CHE. Households who reported having CVD were 3 times more likely to incur CHE compared with households without CVD (OR, 3.002; CI, 1.013-8.902). Conclusions: Our findings suggest that CVD predisposed households to risk of higher CHE. Equity in health financing presupposes that access to health insurance should be predicated on individual health needs. Thus, targeting and prioritizing the health needs of individuals with regard to healthcare financing interventions in SSA is needed.

Cardiovascular Disease and Its Implication for Higher Catastrophic Health Expenditures Among Households in Sub-Saharan Africa

Background: Cardiovascular diseases (CVDs) impose an enormous and growing economic burden on households in sub-Saharan Africa (SSA). Like many chronic health conditions, CVD predisposes families to catastrophic health expenditure (CHE), especially in SSA due to the low health insurance coverage. This study assessed the impact of CVD on the risks of incurring higher CHE among households in Ghana and South Africa. Methods: The World Health Organization (WHO) Study on Global AGEing and Adult Health (WHO SAGE), Wave 1, implemented 2007-2010, was utilized. Following standard procedure, CHE was defined as the health expenditure above 5%, 10%, and 25% of total household expenditure. Similarly, a 40% threshold was applied to household total nonfood expenditure, also referred to as the capacity to pay. To compare the difference in mean CHE by household CVD status and the predictors of CHE, Student’s t-test and logistic regression were utilized. Results: The share of medical expenditure in total household spending was higher among households with CVD in Ghana and South Africa. Households with CVD were more likely to experience greater CHE across all the thresholds in Ghana. Households who reported having CVD were twice as likely to incur CHE at 5% threshold (odds ratio [OR], 1.946; confidence interval [CI], 0.965-1.095), 3 times as likely at 10% threshold (OR, 2.710; CI, 1.401-5.239), and 4 times more likely to experience CHE at both 25% and 40% thresholds, (OR, 3.696; CI, 0.956-14.286) and (OR, 4.107; CI, 1.908-8.841), respectively. In South Africa, households with CVD experienced higher CHE across all the thresholds examined compared with households without CVDs. However, only household CVD status, household health insurance status, and the presence of other disease conditions apart from CVD were associated with incurring CHE. Households who reported having CVD were 3 times more likely to incur CHE compared with households without CVD (OR, 3.002; CI, 1.013-8.902). Conclusions: Our findings suggest that CVD predisposed households to risk of higher CHE. Equity in health financing presupposes that access to health insurance should be predicated on individual health needs. Thus, targeting and prioritizing the health needs of individuals with regard to healthcare financing interventions in SSA is needed.

Adaptation and Development of a Health Insurance Education Program for Adolescent and Young Adult Cancer Patients.

Introduction: Adolescent and young adult (AYA) cancer patients report low health insurance literacy. We interviewed AYAs to gain their perspectives on the content and delivery of the Huntsman-Intermountain adolescent and young adult cancer health insurance (HIAYA CHAT) program. Methods: From October 2019 to March 2020, we interviewed N = 24 insured AYAs with cancer aged 18-39 years. Participants were recruited by study staff and social media. We elicited feedback on proposed HIAYA CHAT content including insurance terms/definitions, insurance coverage components, insurance legislation, cost management, and the suitability of the intervention delivery. Interviews were audio recorded, transcribed, and inductively analyzed using NVivo 12. We coded feedback into three categories of results: (1) delivery of HIAYA CHAT, (2) endorsements of proposed HIAYA CHAT content, and (3) recommendations to expand and improve HIAYA CHAT. Results: Participants were 58% female, 79% non-Hispanic white, and 79% receiving cancer treatment. First, AYAs felt that three to four different content areas, each 30 minutes or less, seemed feasible and that delivery should be through an online platform. Second, participants reflected on times during their treatment when having more insurance knowledge (e.g., appeals process) would have been useful, endorsing content about insurance policies, legal protections, and legislative impacts on health care costs. Third, AYAs recommended evaluating patients' health insurance literacy before starting HIAYA CHAT and wanted concrete learning tools (e.g., sample medical bills and budgeting). Conclusion: AYAs with cancer wanted health insurance education to include information about insurance policies and protections using tangible examples through an online delivery. Describing AYAs preferences for interventions may improve relevance and efficacy of the program. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT04448678.

Deficient state-supported cancer care: A source of deep concern

Deficient state-supported cancer care: A source of deep concern