The Affordable Care Act Attenuates Financial Strain According to Poverty Level

McKenna, Ryan M.; Langellier, Brent A.; Alcalá, Héctor E.; Roby, Dylan H.; Grande, David; Ortega, Alexander N.

doi:10.1177/0046958018790164

Cited by 27 publications

(20 citation statements)

References 27 publications

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“…22,25 For example, federal, state, and county policy initiatives such as Medicaid eligibility expansions, health-care safety nets, and public health programs targeting rural communities may enhance financial well-being, insurance coverage, and access to health care at the county level. 17,[26][27][28][29][30] Although the national recommended surgeon-topopulation ratio by various authorities such as the Graduate Medical Education National Advisory Committee is approximately nine surgeons per 100,000 population, 31,32 surgeon-to-population ratios vary substantially across counties in the United States. 18,33 By one report, about 25% of the US population lives in a county without a general surgeon.…”

Section: Discussionmentioning

confidence: 99%

County-Level Variations in Receipt of Surgery for Early-Stage Non-small Cell Lung Cancer in the United States

Sineshaw

Sahar

Osarogiagbon

et al. 2020

Chest

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BACKGROUND: Although counties are the smallest geographic level for comprehensive healthcare delivery analysis, little is known about county-level variations in receipt of curativeintent surgery for early-stage non-small cell lung cancer (NSCLC) and factors contributing to such variations in the United States.METHODS: A total of 179,189 patients aged $ 35 years who were diagnosed with stage I to II NSCLC between 2007 and 2014 in 2,263 counties were identified from 39 states, the District of Columbia, and Detroit population-based cancer registries; the data were compiled by the North American Association of Central Cancer Registries. The percentage of patients who underwent surgery was calculated for each county with $ 20 cases. Adjusted risk ratios were generated by using generalized estimating equation models with modified Poisson regression.RESULTS: Receipt of surgery for early-stage NSCLC during 2007 to 2014 according to county ranged from 12.8% to 48.6% in the lowest decile of counties, to 74.3% to 91.7% in the highest decile of counties. There were pockets of low surgery receipt rate counties within each state. For example, there was a 25% absolute difference between the lowest and highest surgery receipt rate counties in Massachusetts. Counties in the lowest quartile for receipt of surgery were those with a high proportion of non-Hispanic black subjects, high poverty and uninsured rates, low surgeon-to-population ratio, and nonmetropolitan status.CONCLUSIONS: Receipt of curative-intent surgery for early-stage NSCLC varied substantially across counties in the United States, with pockets of low receipt counties in each state. Low surgery receipt counties were characterized by unfavorable area-level socioeconomic and health-care delivery factors. CHEST 2020; 157(1):212-222

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Section: Discussionmentioning

confidence: 99%

County-Level Variations in Receipt of Surgery for Early-Stage Non-small Cell Lung Cancer in the United States

Sineshaw

Sahar

Osarogiagbon

et al. 2020

Chest

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“…As states participating in BRFSS changed over this period and adoption of the Medicaid expansion varied by state, the impact of changes in the healthcare coverage system on health metrics among this low‐wage workforce could not be evaluated in these analyses. Some research has shown improved healthcare access and some health metrics following the implementation of the ACA, particularly in states that expanded Medicaid . However, the results of other studies highlight residual inequities in access to care due to structural issues ranging from the reluctance of some providers to accept Medicaid patients and inability to afford coinsurance, particularly among the working poor, to lack of transportation, childcare, and employer‐provided time off for preventive care visits .…”

Section: Discussionmentioning

confidence: 99%

Patient care aides: Differences in healthcare coverage, health‐related behaviors, and health outcomes in a low‐wage workforce by healthcare setting

Silver

Boiano

2019

American J Industrial Med

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Objectives: Patient care aides, who provide basic care to patients in a variety of healthcare settings, have been observed to have higher prevalences of adverse health metrics than the general US workforce. However, few studies have examined how healthcare access and health behaviors and outcomes among patient care aides differ by work setting (home health, nursing home, and hospital).Methods: Data from the 2013 to 2016 Behavioral Risk Factor Surveillance System were used to assess the prevalences of healthcare access, health-related behaviors, and health outcomes among patient care aides in different work settings, and among nurses (licensed vocational/practical and registered). Adjusted prevalence ratios were used to compare prevalences for healthcare workers to those for nonhealthcare clerical workers.Results: Overall, patient care aides are a low-wage workforce with high prevalences of multiple adverse health metrics and low prevalences of positive health behaviors compared to clerical workers. Results differed by work setting. Home health aides had the lowest income levels and most adverse results for multiple metrics; nursing home aides had better healthcare access and somewhat better health outcomes.Most metrics were best (though still quite poor) for hospital aides, who showed few significant differences from clerical workers. Conclusions:These results show the need to focus resources on the patient care aide workforce, particularly those in home health. While some needs of nursing home aides, such as improving influenza vaccination coverage and reducing the prevalence of arthritis-related conditions, would benefit from standardized workplace interventions, alternate, workplace-specific approaches are needed for home health aides.

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“…In the years before the ACA, low-income women were less likely to receive lifesaving recommended cancer screenings [39]. A new study found that the ACA was associated with improvements in health care-related financial strain [40]. However, socioeconomic disparities remained in term of mammograms and Pap tests utilization.…”

Section: Discussionmentioning

confidence: 99%

Impact of removing cost sharing under the affordable care act (ACA) on mammography and pap test use

et al. 2019

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Background The Affordable Care Act (ACA) required private insurers and Medicare to cover recommended preventive services without any cost sharing to improve utilization of these services. This study is an attempt to identify the impact of removing cost sharing on mammography and pap test utilization rates. Methods Counterfactual analysis was used to predict what would have been the screening rates in post-ACA if ACA was not there. This was done by estimating a model that examines determinants of dependent variable for the pre-ACA year (pre-ACA year is 2009). The estimated model was then used to predict the dependent variable for the post-ACA year using individual characteristics and other relevant variables unlikely to be affected by ACA (post-ACA year is 2016). Effect of ACA is defined as the difference between the values of dependent variables in post-ACA and the predicted values of dependent variables in the post-ACA year using counterfactual. Results The counterfactual analysis show that the utilization of mammogram and pap test did not improve following ACA. Conclusion Removal of cost-sharing under the ACA did not improve mammography or pap test rates. Therefore, financial barrier may not be an important factor in affecting utilization of the screening tests and policy makers should focus on other non-financial barriers in order to improve coverage of the tests.

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The Affordable Care Act Attenuates Financial Strain According to Poverty Level

Cited by 27 publications

References 27 publications

County-Level Variations in Receipt of Surgery for Early-Stage Non-small Cell Lung Cancer in the United States

County-Level Variations in Receipt of Surgery for Early-Stage Non-small Cell Lung Cancer in the United States

Patient care aides: Differences in healthcare coverage, health‐related behaviors, and health outcomes in a low‐wage workforce by healthcare setting

Impact of removing cost sharing under the affordable care act (ACA) on mammography and pap test use

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