Health Insurance Is Associated With Preventive Care but Not Personal Health Behaviors

Jerant, Anthony F; Fiscella, Kevin; Tancredi, Daniel J.; Franks, Peter

doi:10.3122/jabfm.2013.06.130054

Cited by 48 publications

(38 citation statements)

References 42 publications

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“…Covariates, which were selected based on the scientific literature and are shown with their categorization in Table 1, included sociodemographic factors (i.e., age, race/ethnicity, nativity, religion in which raised, place of residence, relationship status, educational attainment, household poverty level, and employment status, which we conceptualized as potential confounders), health care access indicators (i.e., health insurance status and usual source of care, which we conceptualized as potential mediators (Kerker et al, 2006; Solarz, 1999; Gonzales and Blewett, 2014; Jerant et al, 2013)), and STI diagnosis history (i.e., ever diagnosed with herpes or syphilis and diagnosed with chlamydia or gonorrhea in the past year, which we conceptualized as potential mediators (Everett, 2013)). Data on sex of lifetime sexual partners and sexual identity were missing for 0.8% (n = 87) and 1.0% (n = 128) of women, respectively.…”

Section: Methodsmentioning

confidence: 99%

“…Moreover, it is possible that health insurance status and access to health care, which differ based on sexual orientation and influence the use of preventive health services, may help explain sexual health care disparities related to sexual behavior and identity among U.S. women (Kerker et al, 2006; Solarz, 1999; Institute of Medicine, 2011; Gonzales and Blewett, 2014; Jerant et al, 2013). Similarly, sexual orientation disparities in sexual health services use may be due to sexual risk factors (e.g., history of STIs), which disproportionately affect self-identified bisexual women and women with both male and female sexual partners and may lead clinicians to provide sexual health care to women in these sexual orientation groups more often than those at lower average sexual risk (Everett, 2013; Rosario et al, 2014b; Austin et al, 2008a; McCauley et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

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Sexual orientation and sexual health services utilization among women in the United States

Agénor

Muzny

Schick

et al. 2017

Preventive Medicine

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Although sexual minority women are at risk of sexually transmitted infections (STIs) and cervical cancer, few nationally representative studies have assessed sexual orientation disparities in sexual health care among women. Using data from the 2011–2013 and 2013–2015 waves of the National Survey of Family Growth, which provide a national probability sample of U.S. women aged 15–44 years (N=11,300), we used multivariable logistic regression to examine the associations between sexual behavior and sexual identity (modeled separately) and STI testing in the past year, Pap test use in the last 3 years, lifetime HIV testing, and lifetime human papillomavirus (HPV) testing. Women with male and female lifetime sexual partners had higher adjusted odds of being tested for STIs ([odds ratio:] 1.61; [95% confidence interval:] 1.37–1.89), HIV (1.66; 1.29–2.14), and HPV (1.79; 1.41–2.25) and similar adjusted odds of obtaining a Pap test (0.98; 0.76–1.27) than women with only male lifetime sexual partners. Self-identified bisexual women had higher adjusted odds of obtaining an STI (1.43; 1.10–1.86) and HIV (1.69; 1.24–2.30) test but lower adjusted odds of obtaining a Pap test in the last 3 years (0.66; 0.47–0.93) than heterosexual-identified women. Women with only female lifetime sexual partners had lower adjusted odds of receiving an STI (0.14; 0.07–0.28) and Pap (0.10; 0.03–0.27) test than women with only male lifetime sexual partners. Results comparing self-identified lesbian and heterosexual women were similar. Health care facilities should monitor and address sexual orientation disparities in women’s sexual health care and ensure the provision of high-quality sexual health services to all women.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sexual orientation and sexual health services utilization among women in the United States

Agénor

Muzny

Schick

et al. 2017

Preventive Medicine

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show abstract

“…Jerant et al 4 reported that patients who newly obtained health insurance after being uninsured clearly receive more recommended preventive care that are based on the health system (eg, Papanicolaou tests, mammograms, and immunizations); the opposite is also true: losing insurance decreases these services. Yet patients' personal health behaviors did not improve or worsen with changes in health insurance.…”

Section: Effects Of Insurance On Preventive Services and Health Behavmentioning

confidence: 94%

Family Physicians Improve Patient Health Care Quality and Outcomes

Bowman¹,

Neale²

2013

The Journal of the American Board of Family Medicine

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This issue exemplifies family physicians' ability to provide great care and to continuously improve. For example, beyond other specialty care, the care provided by family physicians is associated with improved melanoma diagnosis and outcomes and improved preventive services for those with a history of breast cancer. Electronic health records are providing new avenues to both assess outcomes and influence care. However, to truly reward quality care, simplistic and readily measurable items such as laboratory results or assessment of the provision of preventive services must be adjusted for risk. Health insurance influences classic preventive care services more than personal health behaviors. The care provided at federally qualified health centers throughout the nation is highly appreciated by the people they serve and is not plagued by the types of disparities in other settings. (J Am Board Fam Med 2013; 26:617-619.)Maly et al 1 show the positive impact of family physicians on recommended preventive services in the follow-up care of underserved female breast cancer survivors. The disparity between specialities was dramatic for colonoscopy in particular, where only a quarter of patients seeing only surgeons/ cancer specialists for follow-up received the recommended screening.Related to another cancer-melanoma-Roetzheim et al 2 showed that visiting a family physician compared with only a dermatologist before the diagnosis of melanoma was associated with a diagnosis of more thin melanomas and possibly a lower rate of mortality. To improve the accuracy of detection of skin cancers, Eide et al 3 tested an intriguing intervention using a readily available, 1-to 2-hour, interactive web-based course. In addition to evaluations after the course, this study considered referrals to dermatology before and after the course and diagnoses after the course. Most of the providers had trained in internal medicine. The evaluations immediately and after 6 months found improved scores, and the later practice patterns found fewer referrals to dermatology but no obvious change in the rate of diagnosis of skin cancers. The physicians reporting no past dermatology training had the greatest improvement. Effects of Insurance on Preventive Services and Health BehaviorsJerant et al 4 reported that patients who newly obtained health insurance after being uninsured clearly receive more recommended preventive care that are based on the health system (eg, Papanicolaou tests, mammograms, and immunizations); the opposite is also true: losing insurance decreases these services. Yet patients' personal health behaviors did not improve or worsen with changes in health insurance. Unfortunately, this questions the ability of the health care system to either recognize negative patient behaviors, assist patients in changing them, or both. Perhaps follow-up longer than 1 year would change these outcomes since behavior changes often take repeated efforts over multiple years.

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“…However, some studies find that, because of ex-ante moral hazard, medical insurance increases the propensity to heavy smoking [11]. Later, Jerant and his research team explain that ex-ante moral hazard means lower the personal cost of unhealthy behavior leading to higher medical services utilization but ex-post moral hazard describes higher health care utilization leading to higher the utilization of preventive care [12]. Preventive cares, like smoking-cessation clinic, have already caught public's attention, Xiao's research team demands for public medical insurance to cover smoking cessation medication for helping Chinese smokers to quit smoking [13].…”

Section: The Role Of Medical Insurance In the Chinese Elders' Behaviomentioning

confidence: 99%

“…One possible reason is adverse selection that new rural cooperative medical insurance is based on voluntary participation and heavy subsidized by the government, so those rural residents with worse health conditions, probably caused by smoking behaviors, are more likely to participate in the medical insurance than those with better health conditions [60]. Another possible reason is ex-post moral hazard that at present outpatient services and drugs for smoking cessation are not included in the scope of the medical insurance and new rural cooperative medical insurance cannot make sure that the elderly have sufficient funds to purchase the service of smoking cessation [12]. In addition, the rural elderly have a rather low level of education and cannot easily accept the view that smoking does harm to health [61].…”

Section: The Behavior Of Quit Smokingmentioning

confidence: 99%

The Role of Medical Insurance in the Chinese Elders’ Behaviors of Smoking and Quit Smoking

Zhi-Lei¹,

Wang²,

Kin-Sun³

et al. 2017

UCMS

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PURPOSE: In the midst of rapid ageing population and rising medical cost, smoking cessation policy is more emphasized by the governments in China than ever. They have taken a public health approach to reform their medical care system, in which policy under an innovative public health reform process is hammered out to reduce the impact of ageing population and rising prevalence rates of chronic diseases on medical expenditure. However, there are very limited studies on the relationship between China's medical care system and elderly smoking behaviors. DESIGN/METHODOLOGY/APPROACH: The study adopts national elderly data, namely the China Health and Retirement Longitudinal Study (CHARLS), to investigate into the relationship between medical care system and elderly smoking behaviors with control variables, including socio-economic background, disability status and chronic diseases. FINDINGS: According to the results of logistics regression model, there is no significant relationship between smoking behavior and the medical insurance for urban residents and urban employees, whereas new rural cooperative medical insurance is positively correlated to the likelihood of smoking and negatively correlated to the likelihood to quit smoking among the elderly population. Besides, aged above 75, having chronic diseases and visual disability increase the likelihood to quit smoking, but no formal education and hearing disability decrease the likelihood to quit smoking. Aged above 75 and married lower the likelihood of smoking, but male, having hearing disability and respiratory disease enhance the likelihood of smoking. ORIGINALITY/VALUE: China's medical care system has not yet fully utilized its role in public health approach and the governments may modify their smoking cessation policies and practices to become preventive rather than reactive by taking reference to the findings of this paper.

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Health Insurance Is Associated With Preventive Care but Not Personal Health Behaviors

Cited by 48 publications

References 42 publications

Sexual orientation and sexual health services utilization among women in the United States

Sexual orientation and sexual health services utilization among women in the United States

Family Physicians Improve Patient Health Care Quality and Outcomes

The Role of Medical Insurance in the Chinese Elders’ Behaviors of Smoking and Quit Smoking

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