Will Health Care Reform Reduce Disparities in Insurance Coverage?

Shane, Dan M.; Ayyagari, Padmaja

doi:10.1097/mlr.0000000000000134

Cited by 35 publications

(42 citation statements)

References 5 publications

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“…To reduce health disparities in vulnerable populations, the present study highlights the need to develop multilingual measurement tools. [27][28][29]31 Secondary findings that support the potential applications of tablet-based PROM approaches were also observed in the present study. Specifically, associations were found between PROMIS-10 scores and mRS scores in stroke patients and between PROMIS-10 and QOLIE scores in patients with epilepsy.…”

Section: Figuresupporting

confidence: 71%

“…15,25 However, delivery models described in the literature contain substantial methodological differences, including various clinical settings, patient characteristics collected, and survey technologies. 15,17,[26][27][28][29] Many cases fail to report participation rate. 17,30 A prior study demonstrates the collection of patient-reported outcomes (i.e., PROMIS physical functional scale) at an academic cerebrovascular clinic using an electronic platform over a time frame of 33 months, reaching 1,946 stroke patients.…”

Section: Figurementioning

confidence: 99%

“…The participation rate of our study was comparable to that of studies that reported the participation rate and targeted a sample size of at least 500 patients (participation rate 38%-73%). 15,28,29 Likewise, our methods share strategic elements used in the most successful studies, including a well-designed electronic survey system, algorithms for tailoring item selection, and integration with patient health records. 17 …”

Section: Figurementioning

confidence: 99%

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Feasibility of the collection of patient-reported outcomes in an ambulatory neurology clinic

et al. 2016

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Objective: To determine whether patients could self-report physical and mental health assessments in the waiting room and whether these assessments would be associated with modified Rankin Scale (mRS) and Quality of Life in Epilepsy (QOLIE-10) scores.Methods: We offered iPad-based surveys to consecutive adult neurology patients at check-in to collect patient-reported outcome measures (PROMs). We collected demographic and clinical data on 6,075 patients through survey or administrative claims and PROMs from participating patients. We compared demographic characteristics of participants and nonparticipants and tested associations between physical and mental health scores and mRS and QOLIE-10.Results: Of 6,075 patients seen by neurologists during the study period, 2,992 (49.3%) participated in the survey. Compared to nonparticipating patients, participating patients more often were privately insured (53.5% vs 42.7%, p , 0.01), married (51.5% vs 47.9%, p , 0.01), and seen in general neurology (nonsubspecialty) clinics (53.1% vs 46.6%, p , 0.01) and more likely to report English as their preferred language (50.1% vs 38.4%, p , 0.01). Participating patients had a mean physical health T score of 28.7 (SD 15) and mental health T score of 33 (SD 15), which were 3 and 2 SD worse than the average for the US general population, respectively.

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Section: Figuresupporting

confidence: 71%

Section: Figurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

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Feasibility of the collection of patient-reported outcomes in an ambulatory neurology clinic

et al. 2016

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“…4 Several studies have supported the finding that the new law has decreased the number of uninsured young adults by increasing the prevalence of private insurance coverage. [5][6][7][8][9][10] The uninsured rate for this age group is projected to continue to fall with implementation of state Medicaid expansions and insurance exchanges. 5 Uninsured young adults encounter barriers when accessing other health care services, such as being unable to afford prescription drugs.…”

Section: Introductionmentioning

confidence: 99%

Effects of the Affordable Care Act's young adult insurance expansion on prescription drug insurance coverage, utilization, and expenditures

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Arora

2016

Research in Social and Administrative Pharmacy

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“…One perspective is that the ACA will have the paradoxical effect of increasing health disparities across states, particularly among racial minorities [4]. Initial evaluations of the health insurance uptake since the ACA substantiate this claim [5]. …”

Section: Introductionmentioning

confidence: 99%

Variation in type and frequency of diagnostic imaging during trauma care across multiple time points by patient insurance type

et al. 2016

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BackgroundResearch has shown that uninsured patients receive fewer radiographic studies during trauma care, but less is known as to whether differences in care are present among other insurance groups or across different time points during hospitalization. Our objective was to examine the number of radiographic studies administered to a cohort of trauma patients over the entire hospital stay as well as during the first 24-hours of care.MethodsPatient data were obtained from an American College of Surgeons (ACS) verified Level I Trauma Center between January 1, 2011 and December 31, 2012. We used negative binomial regression to construct relative risk (RR) ratios for type and frequency of radiographic imaging received among persons with Medicare, Medicaid, no insurance, or government insurance plans in reference to those with commercial indemnity plans. The analysis was adjusted for patient age, sex, race/ethnicity, injury severity score, injury mechanism, comorbidities, complications, hospital length of stay, and Intensive Care Unit (ICU) admission.ResultsA total of 3621 records from surviving patients age > =18 years were assessed. After adjustment for potential confounders, the expected number of radiographic studies decreased by 15 % among Medicare recipients (RR 0.85, 95 % CI 0.78–0.93), 11 % among Medicaid recipients (0.89, 0.81–0.99), 10 % among the uninsured (0.90, 0.85–0.96) and 19 % among government insurance groups (0.81, 0.72–0.90), compared with the reference group. This disparity was observed during the first 24-hours of care among patients with Medicare (0.78, 0.71–0.86) and government insurance plans (0.83, 0.74–0.94). Overall, there were no differences in the number of radiographic studies among the uninsured or among Medicaid patients during the first 24-hours of care compared with the reference group, but differences were observed among the uninsured in a sub-analysis of severely injured patients (ISS > 15).ConclusionsBoth uninsured and insured patients treated at a not-for-profit verified Level I Trauma Center receive fewer radiographic studies than patients with commercial indemnity plans, even after adjusting for clinical and demographic confounders. There is less disparity in care during the first 24-hours, which suggests that patient pathology is the determining factor for radiographic evaluation during the acute care phase. Results from this study offer initial evidence of disparity in diagnostic imaging across multiple insurance groups over different periods of trauma care.

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Will Health Care Reform Reduce Disparities in Insurance Coverage?

Cited by 35 publications

References 5 publications

Feasibility of the collection of patient-reported outcomes in an ambulatory neurology clinic

Feasibility of the collection of patient-reported outcomes in an ambulatory neurology clinic

Effects of the Affordable Care Act's young adult insurance expansion on prescription drug insurance coverage, utilization, and expenditures

Variation in type and frequency of diagnostic imaging during trauma care across multiple time points by patient insurance type

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