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Uninsured Population (uninsured + population)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

The Emergency Medical Treatment and Labor Act as a Federal Health Care Safety Net Program

ACADEMIC EMERGENCY MEDICINE, Issue 11 2001
W. Wesley Fields MD
Abstract Despite the greatest economic expansion in history during the 1990s, the number of uninsured U.S. residents surpassed 44 million in 1998. Although this number declined for the first time in recent years in 1999, to 42.6 million, the current economic slow-down threatens once again to increase the ranks of the uninsured. Many uninsured patients use hospital emergency departments as a vital portal of entry into an access-improverished health care system. In 1986, Congress mandated access to emergency care when it passed the Emergency Medical Treatment and Labor Act (EMTALA). The EMTALA statute has prevented the unethical denial of emergency care based on inability to pay; however, the financial implications of EMTALA have not yet been adequately appreciated or addressed by Congress or the American public. Cuts in payments from public and private payers, as well as increasing demands from a larger uninsured population, have placed unprecedented financial strains on safety net providers. This paper reviews the financial implications of EMTALA, illustrating how the statute has evolved into a federal health care safety net program. Future actions are proposed, including the pressing need for greater public safety net funding and additional actions to preserve health care access for vulnerable populations. [source]

Assessing horizontal equity in medication treatment among elderly Mexicans: which socioeconomic determinants matter most?

HEALTH ECONOMICS, Issue 10 2008
Jürgen Maurer
Abstract Many low- and middle-income countries are currently undergoing a dramatic epidemiological transition, with an increasing disease burden due to degenerative noncommunicable diseases. Inexpensive medication treatment often represents a cost-effective means to prevent, control or cure many of these health conditions. Using micro-data from the 2001 Mexican Health and Aging Study, we assess horizontal inequity in medication treatment among older Mexicans before the introduction of Popular Health Insurance in Mexico. In doing so, we investigate the role of various dimensions of socioeconomic status for obtaining indicated medication treatment within a comparatively fragmented health-care system that features relatively high out-of-pocket expenditures. Our empirical analysis suggests health insurance coverage as a key socioeconomic determinant of indicated medication use with large and statistically significant positive effects on take-up. The effects of insurance status thereby clearly dominate any other possible effects of socioeconomic status on medication treatment. Our results thus highlight the importance of access to reliable health care and comprehensive coverage for rational medication use in the management of degenerative diseases. In light of this evidence, we expect that recent Mexican health-care reforms, which expand health insurance coverage to the previously uninsured population, will alleviate socioeconomic gradients in medication treatment among older people in need. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Presence of a Community Health Center and Uninsured Emergency Department Visit Rates in Rural Counties

THE JOURNAL OF RURAL HEALTH, Issue 1 2009
FAAFP, FACPM, George Rust MD
ABSTRACT:,Context: Community health centers (CHCs) provide essential access to a primary care medical home for the uninsured, especially in rural communities with no other primary care safety net. CHCs could potentially reduce uninsured emergency department (ED) visits in rural communities. Purpose: We compared uninsured ED visit rates between rural counties in Georgia that have a CHC clinic site and counties without a CHC presence. Methods: We analyzed data from 100% of ED visits occurring in 117 rural (non-metropolitan statistical area [MSA]) counties in Georgia from 2003 to 2005. The counties were classified as having a CHC presence if a federally funded (Section 330) CHC had a primary care delivery site in that county throughout the study period. The main outcome measure was uninsured ED visit rates among the uninsured (all-cause ED visits and visits for ambulatory care sensitive conditions). Poisson regression models were used to examine the relationship between ED rates and the presence of a CHC. To ensure that the effects were unique to the uninsured population, we ran similar analyses on insured ED visits. Findings: Counties without a CHC primary care clinic site had 33% higher rates of uninsured all-cause ED visits per 10,000 uninsured population compared with non-CHC counties (rate ratio [RR] 1.33, 95% confidence interval [CI] 1.11-1.59). Higher ED visit rates remained significant (RR 1.21, 95% CI 1.02-1.42) after adjustment for percentage of population below poverty level, percentage of black population, and number of hospitals. Uninsured ED visit rates were also higher for various categories of diagnoses, but remained statistically significant on multivariate analysis only for ambulatory care sensitive conditions (adjusted RR = 1.22, 95% CI 1.01-1.47). No such relationship was found for ED visit rates of insured patients (RR 1.06, 95% CI 0.92-1.22). Conclusions: The absence of a CHC is associated with a substantial excess in uninsured ED visits in rural counties, an excess not seen for ED visit rates among the insured. [source]

The Effect of Ethnicity on the Relationship Between Premature Coronary Artery Disease and Traditional Cardiac Risk Factors Among Uninsured Young Adults

PREVENTIVE CARDIOLOGY, Issue 3 2009
Amit P. Amin MD
Prior studies of premature coronary artery disease (CAD) in young adults did not address the association of race/ethnicity and risk factors. Therefore, the authors conducted a study of 400 patients 40 years and older undergoing coronary angiography at a large, urban public hospital that serves predominately minority, uninsured populations. The prevalence of risk factors and their association with premature CAD varied markedly by ethnic group. Among blacks, dyslipidemia, diabetes, and smoking were independently associated with premature CAD. Among Hispanics, dyslipidemia, male sex, and family history of CAD were independently associated with premature CAD. Smoking was the only risk factor in whites, and no independent risk factor was identified in Asian Indians. Whites and Asian Indians had a higher prevalence of disease than blacks or Hispanics,before and after adjusting for risk factor imbalances across ethnic groups. In this ethnically diverse population, the authors' findings underscore the importance of identifying distinctive risk factors in various ethnic groups. [source]