Who can’t pay for health care?

Weinick, Robin M.; Byron, Sepheen C.; Bierman, Arlene S.

doi:10.1111/j.1525-1497.2005.0087.x

Cited by 48 publications

(40 citation statements)

References 9 publications

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“…While identification of these factors is of interest in its own right, it is particularly important in the New Zealand context, mainly because ensuring equitable access to services is one of the seven fundamental principles guiding the 2001 New Zealand Health Strategy [7]. Secondly, the bulk of research in this area has been carried out mainly on American data and it is important to examine this issue outside the US to see whether the pattern established there applies elsewhere [5,[8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Primary health care in New Zealand: Who has access?

Jatrana

Crampton

2009

Health Policy

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Section: Introductionmentioning

confidence: 99%

Primary health care in New Zealand: Who has access?

Jatrana

Crampton

2009

Health Policy

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“…Recent literature points to the increasing burden of out-of-pocket expenditures, even among insured populations. [15][16][17][18][19] Two previous studies of the role of financial constraints in TKA disparities among Medicare FFS beneficiaries leave a confusing picture. Mahomed et al 4 concluded that those "whose income level was low enough to qualify for Medicaid supplementation were much less likely to undergo total knee replacement than individuals who did not receive Medicaid supplementation," whereas Skinner et al 6 saw "little association between socioeconomic status and the rate of TKA."…”

mentioning

confidence: 99%

Exploring the Determinants of Racial and Ethnic Disparities in Total Knee Arthroplasty

Hanchate¹,

Zhang²,

Felson³

et al. 2008

Medical Care

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Objective-To estimate national total knee arthroplasty (TKA) rates by economic factors, and the extent to which differences in insurance coverage, income, and assets contribute to racial and ethnic disparities in TKA use. Data Source-US longitudinal Health and Retirement Study survey data for the elderly and nearelderly (biennial rounds 1994-2004) from the Institute of Social Research, University of Michigan.Study Design-The outcome is dichotomous, whether the respondent received first TKA in the previous 2 years. Longitudinal, random-effects logistic regression models are used to assess associations with lagged economic indicators.Sample-Sample was 55,469 person-year observations from 18,439 persons; 663, with first TKA.Results-Racial/ethnic disparities in TKA were more prominent among men than women. For example, relative to white women, odds ratios (ORs) were 0.94, 0.46, and 0.79, for white, black, and Hispanic men, respectively (P < 0.05 for black men). After adjusting for economic factors, racial/ ethnic differences in TKA rates for women essentially disappeared, while the deficit for black men remained large. Among Medicare-enrolled elderly, those with supplemental insurance may be more likely to have first TKA compared with those without it, whether the supplemental coverage was private [OR: 1.27; 95% confidence interval (CI): 0.82-1.96] or Medicaid (OR: 1.18; 95% CI: 0.93-1.49). Among the near-elderly (age 47-64), compared with the privately insured, the uninsured were less likely (OR: 0.61; 95% CI: 0.40-0.92) and those with Medicaid more likely (OR: 1.53; 95% CI: 1.03-2.26) to have first TKA.Conclusions-Limited insurance coverage and financial constraints explain some of the racial/ ethnic disparities in TKA rates.Total knee arthroplasty (TKA) is increasingly common with over 431,000 procedures performed nationwide in 2004. 1 For persons with severe and potentially disabling osteoarthritis, TKA is "efficacious and cost-effective …[it] relieves pain and reduces functional disability." 2 As the US population ages, growth in TKAs is expected to accelerate. A study of Canadians aged 55 or older concluded that those with less education and lower income were more likely to need TKA and similarly willing to undergo TKA as those with more education or income. 20 To the extent that these findings apply to the United States, lower TKA utilization among minorities with lower SES is not necessarily due to unwillingness to undergo TKA.A related study of disparities in joint (knee and hip) replacement based on a nationally representative (US) longitudinal survey sample of 6159 Medicare-enrolled adults (age 69 or older) found that those with supplementary Medigap coverage were more likely to have a joint replacement compared with those without. 21 The apparent difference with Skinner et al 6 may be due to the more detailed individual-level financial and insurance coverage measures in Dunlop et al. 21 Although the data used in this study are from the same survey source [Health and Retirement Study (HRS)] as ...

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“…Wirtschaftstheoretische Berechnungen aus Australien gehen von einem 20-prozentigen R ü ckgang des Arzneimittelverbrauchs von Rentnern bei Verdoppelung der Zuzahlung von 2,50 auf 5 Australische Dollar ( $ A) und bei einer Erh ö hung auf 6 $ A sogar von einem R ü ckgang um 34 % aus [14] . Trotz der hohen relativen Steigerung geh ö ren derartige Preise unter australischen Einkommensbedingungen eher in den Bereich der " geringf ü gigen Zuzahlungen " , und dennoch ist der Effekt enorm 18 . Und da Zuzahlungen am st ä rksten und nachhaltigsten auf Medikamente zur Behandlung von Herzkreislauferkrankungen und Bluthochdruck sowie Psychotherapeutika wirken, die Patienten in aller Regel langfristig einnehmen m ü ssen [68] , ist davon auszugehen, dass selbst Eigenbeteiligungen relativ geringen Umfangs relevante Folgen f ü r die Gesundheit einer Bev ö lkerung und negative Auswirkungen auf die gesamten Gesundheitsausgaben verursachen 19 .…”

Section: Fehl-steuerung Der Arzneimittelversorgungunclassified

“…17 Am meisten verbreitet ist die Bitte um Ä rztemuster (39,2 % ), gefolgt von der Einnahme geringerer als der verschriebenen Dosen (23,6 % ), Aussetzen verordneter Arzneimittel (16,3 % ), Verzicht auf andere Bed ü rfnisse (15 % ) und Borgen von Geld f ü r den Medikamentenkauf (12 % ) [46] . 18 Derzeit bestehen in Australien fi xe Zuzahlungen f ü r staatlich anerkannte Arzneimittel, die bestimmten Effi zienz-, Sicherheits-und Qualit ä tskriterien gen ü gen m ü ssen, die pro Packung bei umgerechnet 11,80 US-$ liegen, aber f ü r Personen mit Sozialversicherungsanerkennung (Arbeitslose, Studenten, Arme, Behinderte, etc.) nicht mehr als 1,90 US-$ betragen [78] .…”

Section: Fehl-steuerung Der Arzneimittelversorgungunclassified

“…von Geb ä rmutterhalsabstrichen sowohl bei HMO ' s als auch bei PPO ' s auftrat, w ä hrend die um 3 -9 % verringerte Inanspruchnahme von Mammographien nur bei PPO ' s zu beobachten war[7,16] . 3 Im Jahr 2003 hatten insgesamt 68,6 % der US-B ü rger eine private Krankenversicherungspolice, der ü berwiegende Teil (60,4 % der Bev ö lkerung) war ü ber seinen Arbeitgeber in einer Gruppenversicherung[18] . 4 Einschr ä nkend ist zu betonen, dass die Studie nur rektale Untersuchungen und PSA-Tests ber ü cksichtigt, ohne zwischen beiden Methoden zu unterscheiden.5 Bei gestaffelten Medikamentenzuzahlungen fallen in der Regel die geringsten Eigenbeteiligungen bei Generika an, mittlere Zuzahlungen f ü r erw ü nschte und die h ö chsten Eigenbeteiligungen f ü r nicht erw ü nschte Markenpr ä parate[28,29] 6.…”

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Zuzahlungen im Krankheitsfall - ein taugliches Instrument für mehr Gesundheit? - Ein Literaturüberblick

Holst¹

2008

Z Allg Med

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Who can’t pay for health care?

Cited by 48 publications

References 9 publications

Primary health care in New Zealand: Who has access?

Primary health care in New Zealand: Who has access?

Exploring the Determinants of Racial and Ethnic Disparities in Total Knee Arthroplasty

Zuzahlungen im Krankheitsfall - ein taugliches Instrument für mehr Gesundheit? - Ein Literaturüberblick

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