Digital Commons Network^™

A Systematic Review Of The Social Determinants Of Health In Shoulder Arthroplasty Outcomes, Allison Boland, John Pum, Michael Gaudiani, Matthew A. Gasparro

Medical Student Research Symposium

This systematic review investigates the impact of social determinants of health (SDOH) on outcomes in shoulder arthroplasty (SA). SA, a common orthopedic procedure, has seen an increasing focus on SDOH influencing postoperative results. The study aims to comprehensively assess this impact on both surgical and patient-reported outcomes.

Through a systematic search of databases, 34 studies (2011-2021) met the inclusion criteria, involving 4,825,547 patients. Explored SDOH included insurance status, race/ethnicity, age, sex, income, social support, and veteran status. Outcomes considered were length of stay, American Shoulder and Elbow Surgeons scores, total SA rates, revision rates, complication rates, and discharge status.

Findings …

Structural Sex Discrimination: Why Gynecology Patients Suffer Avoidable Injuries And What The Law Can Do About It, Christopher Robertson, Annabel Kupke, Louise P. King

Faculty Scholarship

The nearly four million Americans who undergo gynecological surgeries each year suffer avoidable lifelong, painful, and disabling injuries. This Article diagnoses the root cause in our legal framework for healthcare finance and identifies legal solutions.

America’s public-private system for reimbursing healthcare pays for procedures rather than outcomes, and it pays substantially more for work on male rather than female anatomies. This disparity is due to the federal government’s reliance on a secretive industry committee to set those rates, and the committee’s reliance on junk science surveys, allowing self-interested and gender-biased responses, contrary to objective measures.

As payors disvalue the bodies …

Journeying Through The Hurdles Of Gender-Affirming Care Insurance: A Literature Analysis., Heli Patel, Justin M. Camacho, Neeku Salehi, Romina Garakani, Leigh Friedman, Chris M. Reid

HPD Articles

Gender-affirming surgery (GAS) has been proven to be successful in the treatment of gender dysphoria. The benefits of providing insurance coverage for transition-related surgeries far surpass the costs of suffering from persistent gender dysphoria, including many positive health outcomes such as decreased rates of substance use, psychiatric illness, and suicide. Despite being deemed a medical necessity, discrepancies in access to treatment and insurance coverage for GAS persist. The purpose of this review is to understand the impact of limited insurance coverage on the well-being of transgender patients. A comprehensive search was conducted utilizing the Preferred Reporting Items for Systematic Reviews …

Factors Associated With Delaying Medical Care: Cross-Sectional Study Of Nebraska Adults, Kendra Ratnapradipa, Snehal Jadhav, Josiane Kabayundo, Hongmei Wang, Lisa C. Smith

Journal Articles: Epidemiology

BACKGROUND: Delayed medical care may result in adverse health outcomes and increased cost. Our purpose was to identify factors associated with delayed medical care in a primarily rural state.

METHODS: Using a stratified random sample of 5,300 Nebraska households, we conducted a cross-sectional mailed survey with online response option (27 October 2020 to 8 March 2021) in English and Spanish. Multiple logistic regression models calculated adjusted odds ratios (aOR) and 95% confidence intervals.

RESULTS: The overall response rate was 20.8% (n = 1,101). Approximately 37.8% of Nebraskans ever delayed healthcare (cost-related 29.7%, transportation-related 3.7%), with 22.7% delaying care in the …

Respect Your Elders: An Examination Of Elder Care In The United States, Amy Jassman

University Honors Program

Insurance, healthcare, and workplace conditions are concerns of many senior citizens in the United States. This paper examines the repercussions of governmental policies and older adult stereotypes on the overall quality of care for older adults in the United States of America. This quality of care will be determined by analyzing how England’s, South Korea’s, Germany’s, Canada’s, and India’s programs and values with respect to elder care have impacted the health and well-being of the elderly. Studies on insurance systems, long-term care facilities, and workplace discrimination will be reviewed and compared. The findings show the United States to be trailing …

Health Informatics Interventions To Minimize Out-Of-Pocket Medication Costs For Patients: What Providers Want., Karalyn A Kiessling, Bradley E Iott, Jessica Pater, Tammy Toscos, Shauna Wagner, Laura M Gottlieb, Tiffany C Veinot

Health Services and Informatics Research

OBJECTIVE: To explore diverse provider perspectives on: strategies for addressing patient medication cost barriers; patient medication cost information gaps; current medication cost-related informatics tools; and design features for future tool development.

MATERIALS AND METHODS: We conducted 38 semistructured interviews with providers (physicians, nurses, pharmacists, social workers, and administrators) in a Midwestern health system in the United States. We used 3 rounds of qualitative coding to identify themes.

RESULTS: Providers lacked access to information about: patients' ability to pay for medications; true costs of full medication regimens; and cost impacts of patient insurance changes. Some providers said that while existing cost-related …

Is Fire Insurable?, Kenneth S. Klein

Faculty Scholarship

The focus of this chapter is on the extant data on the prevalence, causes, and depth of inadequate, unavailable, and/or unaffordable dwelling insurance for fire, and what might be done about it. Whether it is ‘bushfire’ in Australia or ‘wildfire’ in the United States, the frequency, intensity, and cost of fire is increasing, with no reason to expect the upward trend to dissipate any time soon. Most homeowners want to insure their homes for fire and think they both have done so and done so adequately. More often than not, they are wrong. And many are finding that insurance now …

Data Privacy Issues In West Virginia And Beyond: A Comprehensive Overview, Jena Martin

Consumer Law Scholarship

This white paper was commissioned by the Center for Consumer Law and Education, a joint initiative launched by West Virginia University and Marshall University to “coordinate the development of consumer law, policy, and education research to support and serve consumers.”

As such, this paper has a dual purpose. First, it provides a comprehensive overview of the many different legal issues that affect data privacy concerns (both nationally and in West Virginia). Second, it documents and discusses the result of a survey and specific focus groups that were undertaken throughout the fall of 2019 into January 2020 where individuals within the …

Predictors Of Fraudulent Monday Effect Workers Compensation Claims Filing, Sharla St. Rose

FIU Electronic Theses and Dissertations

Monday Effect Claims refer to workers compensation claims filed on Mondays for easy to conceal injuries such as strains, sprains, and back injuries. Researchers and industry experts have long believed that there is an element of fraud in these claims, resulting from individuals who were injured during the weekend, while not at work, looking to take advantage of the medical benefits available through workers compensation insurance. Fraudulent Monday Effect Claims (FMEC), as presented in this study, specifically refer to workers compensation claims filed for injuries that occurred while an individual was not at work, presumably during the weekend.

A study …

Private Insurance Limits And Responses, Elizabeth Weeks

Scholarly Works

The COVID-19 pandemic exposed a number of existing flaws in the United States’ patchwork approach to paying for and providing access to medical care. Shelter-in-place orders, social distancing, and other public health strategies employed to address the pandemic spawned a global recession, causing rapid and high unemployment rates in many countries. The U.S. unemployment rate peaked in April 2020 at 14.7%, higher than in any previous period since World War II. The United States has long hewed an anachronistic policy of relying heavily on private employers to provide health insurance to a substantial portion of the population. Those who are …

Three Essays Of Assessing The Risk, Adaptation And Resilience To Natural Disasters, Mohammad Asif Hasan Khan

FIU Electronic Theses and Dissertations

This dissertation consists of three chapters in environmental and natural resource economics. In the first chapter, using survey data, I investigate what factors are important in people's evacuation decisions in the coastal areas of Bangladesh. I examine if temporal spillover is present in their decision making and how significant the spillover effect is. With that objective in mind, I examine the effect of previous evacuation experience on future evacuation decision. I also analyze how network effects influence people's evacuation decisions during a natural disaster.

As the threat of climate change grows, communities around the world are facing the dangers of …

Demographics Of Opioid Prescriptions, Isaac Linton, Simon Condliffe

Economics & Finance Student Work

The author ran Linear Probability Model and Logistic Model regressions on data from the 2017 Medical Expenditures Panel Survey to determine demographics of opioid prescriptions. The dependent variable was opioid prescription received (Y/N) and independent variables included age, education level, relative income, race, insurance status, etc. Results of the regressions showed that people with public or private insurance are more likely to be prescribed an opioid, that the problem mainly affects white people, and that as educational attainment increases, likelihood of opioid prescription decreases.

Women In Law Leadership: Inaugural Lecture: A "Fireside Chat" With Gillian Lester 2-18-2020, Roger Williams University School Of Law, Michael M. Bowden, Andrea Hansen

School of Law Conferences, Lectures & Events

No abstract provided.

Ensuring An Underclass: Stigma In Insurance, Valarie K. Blake

Scholarly Works

In our country, access to insurance can be a matter of life and death, as well as financial security. Despite these great stakes, the ability to get affordable insurance is often influenced by social factors like sexual orientation, age, gender, and race. Insurers defend these practices, and regulators frequently agree, on the basis of actuarial fairness. That is, some groups are costlier to insure and others shouldn’t have to offset their expenses. This article advances a stigma-based critique to challenge this conception of lawful discrimination and fairness in insurance. The sociological stigma literature tells us that it is a natural …

Law Library Blog (November 2019): Legal Beagle's Blog Archive, Roger Williams University School Of Law

Law Library Newsletters/Blog

No abstract provided.

Identifying The Legitimate Role Of The Value Of A Statistical Life In Legal Contexts, W. Kip Viscusi

Vanderbilt Law School Faculty Publications

This article is based on my keynote address at the American Academy of Economic and Financial Experts conference in which I examined some of the implications for legal contexts of my book, Pricing Lives: Guideposts for a Safer Society. The value of a statistical life (VSL) provides an economic measure of the efficient cost-risk tradeoff rate for mortality risk decisions. Consequently, the VSL is well suited to serving as a measure of the benefits of mortality risk reduction for government regulatory policies and for corporate risk decisions. The tort liability counterpart of this function is using the VSL to assess …

Healthism In Tort Law, Elizabeth Weeks

Scholarly Works

This article draws on the author's recently published book, Healthism: Health Status Discrimination and the Law (with Jessica L. Roberts) (Cambridge University Press 2018), examining tort law doctrine and policy for examples of differential treatment of health status or behaviors. Just as scholars previously have drawn attention to discrimination based on race, sex, age, and other protected categories in tort law, the article urges similar examination of tort law's potential to discriminate against the unhealthy. The article discusses the potential for healthism in the reasonably prudent person standard of care, contributory negligence, assumption of the risk, noneconomic damages caps, impaired …

Monthly Spending Dynamics Of The Elderly Following A Health Shock: Evidence From Singapore, Terence C. Cheng, Jing Li, Rhema Vaithianathan

Research Collection School Of Economics

We use novel longitudinal data from 19 monthly waves of the Singapore Life Panel to examine the short-term dynamics of the effects health shocks have on household health and non-health spending and income by the elderly. The health shocks we study are the occurrence of new major conditions such as cancer, heart problems, and minor conditions (e.g. diabetes, and hypertension). Our empirical strategy exploits unanticipated changes in health status through the diagnosis of new health conditions, combined with an individual fixed effect framework. We find that major shocks have large and persistent effects while minor shocks have small and mainly …

The Impact Of Travel Time On Colorectal Cancer Stage At Diagnosis In A Privately Insured Population, Mesnad Alyabsi, Mary Charlton, Jane L. Meza, K. M. Monirul Islam, Amr Soliman, Shinobu Watanabe-Galloway

Journal Articles: Epidemiology

BACKGROUND: Rural residents are less likely to receive screening for colorectal cancer (CRC) than urban residents. However, the mechanisms underlying this disparity, especially among people aged 50-64 years old with private health insurance, are not well understood. We examined the impact of travel time on stage at CRC diagnosis.

METHODS: This retrospective cohort study used data from the Blue Cross and Blue Shield of Nebraska. Members of this private insurance company aged 50-64 years, diagnosed with CRC during the period 2012-2016, and continuously enrolled in the insurance plan for at least 6 months prior to CRC diagnosis, were selected for …

What Happens When Insurers Make The Insurance Laws? State Legislative Agendas And The Occupational Makeup Of Government, Eric Hansen, Nicholas Carnes, Virginia Gray

Political Science: Faculty Publications and Other Works

Do the occupational backgrounds of politicians affect the government’s agenda? Businesses have long thought so. The first occupational data on state legislators were collected by the Insurance Information Institute, an interest group representing major insurance companies. In this paper, we test one potential motive for these kinds of efforts: the idea that the occupational makeup of governments affects the agendas they pursue, an argument that has been largely neglected in research on politicians’ occupational backgrounds. We focus here on the insurance industry. Using original data, we find that state legislatures with more former insurers consider fewer bills regulating insurance (negative …

Cross-Subsidies: Government's Hidden Pocketbook, John Brooks, Brian Galle, Brendan S. Maher

Faculty Scholarship

Governments can use regulation to pay for public goods out of the pockets of consumers, rather than taxpayers. For example, the Affordable Care Act underwrites care for women and the infirm through higher insurance premium payments by healthy men. Building on a classic article from Richard Posner, we show that these “cross-subsidies” between consumers are a common feature of modern law, ranging from telecommunications to intellectual property to employee benefits.

Critics of the ACA, and even some of its supporters, argue that taxes would be a better choice. Taxes are said to be more transparent, and to fit better with …

Cross-Subsidies: Government's Hidden Pocketbook, John R. Brooks, Brian D. Galle, Brendan S. Maher

Georgetown Law Faculty Publications and Other Works

Governments can use regulation to pay for public goods out of the pockets of consumers rather than taxpayers. For example, the Affordable Care Act (ACA) underwrites care for women and the infirm through higher insurance premium payments by healthy men. Building on a classic article from Richard Posner, we show that these “cross- subsidies” between consumers are a common feature of modern law, ranging from telecommunications to intellectual property to employee benefits.

Critics of the ACA, and even some of its supporters, argue that taxes would be a better choice. Taxes are said to be more transparent and to fit …

Evolution Of Insurance: A Telematics-Based Personal Auto Insurance Study, Yuanjing Yao

Honors Scholar Theses

Insurance has been constantly evolving since its inception; nowadays, insurance has become an indispensable part of people’s daily life. Nonetheless, very few individuals understand the mechanism behind their insurance coverage. This paper focuses on the evolution of personal auto insurances. The first part of the paper summarizes traditional pricing techniques for personal auto insurance and discusses their deficiencies. The second part of the paper introduces telematics insurance, an innovative form of auto insurance. This new kind of insurance integrates telematics as well as other technologies in the premium calculation process. The study proceeds to evaluate the pros and cons of …

Hard To Reach: Examining The National Disability Insurance Scheme Experience - A Case Study In Wollongong, Freda C. Hui, Corinne L. Cortese, Mona Nikidehaghani, Sandra H. Chapple, Kellie M. Mccombie

Faculty of Business - Papers (Archive)

We report on interviews conducted to examine the effectiveness of the Australian National Disability Insurance Scheme (NDIS). Our aims were to assess the effectiveness of the NDIS in communicating with people with disabilities who are socio‐economically disadvantaged, to consider the types of assistance required, and to provide recommendations to improve the NDIS. Our interviewees are characterised as ‘hard to reach’, a cohort that is missing out on benefits they might receive under the NDIS because of the socioeconomic disadvantage that compounds their disability hardship. Some of our key findings were that many of our interviewees were unaware of the NDIS, …

Innovations In Rural Health System Development: Federally Qualified Health Center Initiatives, Sara Kahn-Troster Mph, Amanda Burgess Mppm, Andrew F. Coburn Phd

Health System Reform

Part of a series of briefs profiling innovative rural health system transformation models and strategies from Maine and other parts of the US, this brief focuses on promising strategies of federally qualified health centers. These strategies include workforce recruitment and retention initiatives, approaches to serving high-need patient populations, services to address the opioid crisis and dental care, and innovations in providing enabling services that address the social determinants of health.

This series on Innovations in Rural Health System was funded by the Maine Health Access Foundation.

Other briefs in this series include:

• Moving Rural Health Systems to Value-Based Payment
• Recruiting …

Community-Based User Experience: Evaluating The Usability Of Health Insurance Information With Immigrant Patients, Emma J. Rose, R. Racadio, K. Wong, S. Nguyen, J. Kim, A. Zahler

SIAS Faculty Publications

User experience (UX), a common practice in corporate settings, is new for many nonprofit organizations. This case study details a community-based research project between nonprofit staff at a community health center and UX professionals to improve the design and usability of a document designed to help immigrant patients sign up for health insurance. UX professionals may need to adapt and be flexible with their efforts, but can offer valuable skills to community partners. Research questions: (1) What are the information needs and barriers faced by immigrant populations signing up for health insurance? (2) How does a usability study, adapted to …

Tobacco Use And Health Insurance Literacy Among Vulnerable Populations: Implications For Health Reform, Robert T. Braun, Yaniv Hanoch, Andrew J. Barnes

Health Behavior and Policy Publications

Background: Under the Affordable Care Act (ACA), millions of Americans have been enrolling in the health insurance marketplaces. Nearly 20% of them are tobacco users. As part of the ACA, tobacco users may face up to 50% higher premiums that are not eligible for tax credits. Tobacco users, along with the uninsured and racial/ethnic minorities targeted by ACA coverage expansions, are among those most likely to suffer from low health literacy – a key ingredient in the ability to understand, compare, choose, and use coverage, referred to as health insurance literacy. Whether tobacco users choose enough coverage in the marketplaces …

Microchips: Technology That Can Change Medical Services, Dale H. Shao, Ralph E. Mckinney, Lawrence P. Shao

Management Information Systems Faculty Research

Healthcare costs have increased greatly over the last few years. The result is a tremendous burden for businesses and private individuals. Experts say there is no end in sight to this increase. This situation has forced the federal government, state governments, and private industry, to investigate methods to slow down and reduce this constant increase in healthcare costs. Microchip technologies have been presented as a means to ensure better patient care while a/so reducing costs and errors resulting from the current system of healthcare. This paper presents an overview of microchip technology programs, issues with implementation, and future considerations for …

Implementation Of The Affordable Care Act In Physical Therapy, Greg Austin

Mahurin Honors College Capstone Experience/Thesis Projects

Introduction: With the implementation of the Affordable Care Act (ACA) in 2010, many medical specialties prepared to see reimbursement rates altered. Not impervious to this trend was the field of physical therapy (PT). This change in reimbursement structure could impact the effectiveness of PT treatment. Under this model, a patient may not be able to receive the appropriate number of visits to a physical therapist, resulting in a loss of utilization in the injured area and, possibly, a loss of independence. Methods: A literature review was performed to determine reimbursement rate impact on PT. A seven-item open-ended survey regarding various …

Outliving Love: Marital Estrangement In An African Insurance Market, Casey Golomski

Anthropology

Marital estrangement and formal divorce are vital conjunctures for married women’s kinship relations and life course, where a horizon of future possibilities are revalued and negotiated at the interstices of custom, law, and social and ritual obligations. In this article, after delineating the forms of customary and civil marriage and the possibilities for divorce or estrangement from each, I describe how some married women in Swaziland and South Africa mediate this complex social field for their children and families through pensions and continuing to pay for their partners’ insurance coverage. This was not solely out of avarice to reap future …