Medicine and Health Sciences Commons^™

Impact Of A Health Fair On Student Organizations Providing Care To The Detroit Hispanic/Latinx Community And Barriers Affecting Patients Of A Student-Run Clinic Primarily Serving This Population, Amanda Rodriguez Bs, Lucas Edgren Bs, Sanjana Rao Bsph, Diane L. Levine Md, Jennifer Mendez Phd, Joel Appel Do

Medical Student Research Symposium

Current literature shows Hispanic/Latinx populations in the U.S. face health inequities. Amigos Medicos (AM) Clinic, located in Southwest Detroit, is a student-run free clinic that addresses these issues through preventive health screenings. We hosted a health fair in 2022 and invited other student organizations in efforts to connect the community to resources. Our aim is to identify specific barriers faced by our population in receiving health care and to identify the impact of participation in the fair on those organizations. One survey was administered to patients attending clinic that identified health barriers they face. The other survey was administered to …

Financing Mechanisms Applied For Successful Universal Health Coverage In Malaysia, Thailand And Singapore - Lessons For Pakistan, Rawshan Jabeen, Unaib Rabbani, Nazish Abbas

Community Health Sciences

Universal health coverage is a global agenda and, currently for Pakistan, achieving this goal is a challenge because of a number of constraints. The current narrative review was planned to describe an overview of the provision of health insurance in Malaysia, Thailand and Singapore that have achieved universal health coverage, and to propose a roadmap for Pakistan. Literature search was conducted on Google Scholar and PubMed databases as well as on the World Bank website to retrieve relevant articles. The three studied countries achieved universal health coverage by gradually increasing allocation for health and through various mechanisms, such as health …

Exploring Willingness To Pay For Health Insurance And Preferences For A Benefits Package From The Perspective Of Women From Low-Income Households Of Karachi, Pakistan, Shifa Salman Habib, Shehla Zaidi

Community Health Sciences

Background: Achieving universal health coverage (UHC) and reduction in out of pocket (OOP) expenditures on health, is a critical target of the Sustainable Development Goals (SDG). In low-middle income countries, micro-health insurance (MHI) schemes have emerged as a useful financing tool for laying grounds for Universal Health Coverage. The aim of this study was to provide evidence for designing a feasible health insurance scheme targeted at urban poor, by exploring preferences for an insurance benefits package and co-payments among women from low-income households in Karachi, Pakistan.
Methods: This was a descriptive cross-sectional study, conducted using household surveys between July-August 2015. …

Health Insurance And The Undocumented Immigrant, Anja Diercks

Honors Theses

The purpose of this thesis is to perform a comparative analysis on how seven different countries (USA, South Africa, Germany, England, Canada, France and Singapore) organize their healthcare system to cope with the issue of undocumented immigrants and whether or not these systems in place were “fair.” The thesis will also explore the possible ways the United States could change to be more inclusive and fairer in the world of healthcare and health insurance for the undocumented immigrant. A study on what fairness means both in ethical and economical terms is done to suggest a new basis of a fair …

An Examination Of The Association Between State Medicaid Perinatal Services And Birth Outcomes, Joy Morgan Myers

Honors Theses

This thesis investigated the connection between socioeconomic status, healthcare coverage, and birth outcomes. The research question that was posed specifically looked at twenty perinatal services that states covered under Medicaid to varying degrees to see their association, if any, with premature birth rates and low birthweight rates. State-level and Mississippi county-level data were compiled regarding preterm birth rates, low birthweight rates, presumptive eligibility adoption, and coverage of twenty different perinatal services. Using these data, the correlation between state Medicaid expansion status and birth outcomes was first calculated in order to determine if variation in birth outcomes was associated with expanded …

Pre-Operative Clinical Variation By Health Insurance Carrier In 12,285 Male Surgical Patients With Moderate Morbid Obesity, Matthew E. Moore D.O., Gus J. Slotman M.D.

Rowan-Virtua Research Day

In the ongoing obesity epidemic, every surgeon now treats patients with weight-related medical problems. In managing these medically fragile surgical patients, every clinical insight helps. While variation according to health insurance has been reported in mixed sex bariatric surgery populations, whether or not clinical characteristics in the subset of moderately obese male surgical patients vary by insurance carrier is unknown. The objective of this study was to identify clinical variation by insurance type in moderately obese men.

Results showed that pre-operative clinical characteristics of moderately obese male surgical patients vary by the health insurance coverage type to which they subscribe. …

Care Of Acute Conditions And Chronic Diseases In Canada And The United States: Rapid Systematic Review And Meta-Analysis, Keren M. Escobar, Dorian Murariu, Sharon Munro, Kevin M. Gorey

Social Work Publications

This study tested the hypothesis that socioeconomically vulnerable Canadians with diverse acute conditions or chronic diseases have health care access and survival advantages over their counterparts in the USA. A rapid systematic review retrieved 25 studies (34 independent cohorts) published between 2003 and 2018. They were synthesized with a streamlined meta-analysis. Very low-income Canadian patients were consistently and highly advantaged in terms of health care access and survival compared with their counterparts in the USA who lived in poverty and/or were uninsured or underinsured. In aggregate and controlling for specific conditions or diseases and typically 4 to 9 comorbid factors …

Breast Cancer Care In California And Ontario: Primary Care Protections Greatest Among The Most Socioeconomically Vulnerable Women Living In The Most Underserved Places, Kevin M. Gorey, Caroline Hamm, Isaac N. Luginaah, Guangyong Zou, Eric J. Holowaty

Social Work Publications

Background: Better health care among Canada’s socioeconomically vulnerable versus America’s has not been fully explained. We examined the effects of poverty, health insurance and the supply of primary care physicians on breast cancer care. Methods: We analyzed breast cancer data in Ontario (n = 950) and California (n = 6300) between 1996 and 2000 and followed until 2014. We obtained socioeconomic data from censuses, oversampling the poor. We obtained data on the supply of physicians, primary care and specialists. The optimal care criterion was being diagnosed early with node negative disease and received breast conserving surgery followed by adjuvant radiation …

Social Health Insurance Coverage And Financial Protection Among Rural-To-Urban Internal Migrants In China: Evidence From A Nationally Representative Cross-Sectional Study, Wen Chen, Qi Zhang, Andre M. N. Renzaho, Fangjing Zhou, Hui Zhang, Li Ling

Community & Environmental Health Faculty Publications

INTRODUCTION: Migrants are a vulnerable population and could experience various challenges and barriers to accessing health insurance. Health insurance coverage protects migrants from financial loss related to illness and death. We assessed social health insurance (SHI) coverage and its financial protection effect among rural-to-urban internal migrants (IMs) in China.

METHODS: Data from the '2014 National Internal Migrant Dynamic Monitoring Survey' were used. We categorised 170 904 rural-to-urban IMs according to their SHI status, namely uninsured by SHI, insured by the rural SHI scheme (new rural cooperative medical scheme (NCMS)) or the urban SHI schemes (urban employee-based basic medical insurance (UEBMI)/urban …

The Role Of Neighborhood Characteristics In Late Stage Melanoma Diagnosis Among Hispanic Men In California, Texas, And Florida, 1996-2012, Valerie M. Harvey, Clinton W. Enos, Jarvis T. Chen, Hadiza Galadima, Karl Eschbach

Community & Environmental Health Faculty Publications

Background. Hispanics diagnosed with cutaneous melanoma are more likely to present at advanced stages but the reasons for this are unknown. We identify census tracts at high risk for late stage melanoma diagnosis (LSMD) and examine the contextual predictors of LSMD in California, Texas, and Florida. Methods. We conducted a cross-sectional study using geocoded state cancer registry data. Using hierarchical multilevel logistic regression models we estimated ORs and 95% confidence intervals for the impact of socioeconomic, Hispanic ethnic concentration, index of dissimilarity, and health resource availability measures on LSMD. Results. We identified 12,493 cases. In California, late …

Getting Ready For Open Enrollment: Supporting Clients Living With Hiv, Juli Powers, Mira Levinson, Naima Cozier

9th Annual Rural HIV Research and Training Conference (2014-2019)

Open Enrollment for 2017 Marketplace plans begins on November 1, 2016. Programs should prepare now to engage unenrolled and newly-eligible clients, and support clients who enrolled in previous years to compare options and find affordable, quality plans for 2017 that meet their needs. This interactive session will include strategies to engage and enroll people living with HIV in health coverage.

Palliative Chemotherapy Among People Living In Poverty With Metastasised Colon Cancer: Facilitation By Primary Care And Health Insurance, Kevin M. Gorey, Emma Bartfay, Sindu M. Kanjeekal, Frances C. Wright, Caroline Hamm, Isaac N. Luginaah, Guangyong Zou, Eric J. Holowaty, Nancy L. Richter, Madhan K. Balagurusamy

Social Work Publications

Background: Many Americans with metastasised colon cancer do not receive indicated palliative chemotherapy. We examined the effects of health insurance and physician supplies on such chemotherapy in California.

Methods: We analysed registry data for 1199 people with metastasised colon cancer diagnosed between 1996 and 2000 and followed for 1 year. We obtained data on health insurance, census tract-based socioeconomic status and county-level physician supplies. Poor neighbourhoods were oversampled and the criterion was receipt of chemotherapy. Effects were described with rate ratios (RR) and tested with logistic regression models.

Results: Palliative chemotherapy was received by less than half of the participants …

Disparities In Access To Preventive Health Care Services Among Insured Children In A Cross Sectional Study, Christian King

Department of Nutrition and Health Sciences: Faculty Publications

Children with insurance have better access to care and health outcomes if their parents also have insurance. However, little is known about whether the type of parental insurance matters. This study attempts to determine whether the type of parental insurance affects the access to health care services of children. I used data from the 2009–2013 Medical Expenditure Panel Survey and estimated multivariate logistic regressions (N=26,152). I estimated how family insurance coverage affects the probability that children have a usual source of care, well-child visits in the past year, unmet medical and prescription needs, less than 1 dental visit per year, …

Social Actors Fight The Rising Tide Of Hiv In U.S. Southern Poor, Courtenay Sprague, Sara E. Simon

Center for Peace, Democracy and Development Publications

The greatest number of persons living with HIV in the United States are now living in the South, and they face poorer health outcomes and increased AIDS-related deaths as compared to the rest of the country. The southern United States has a disproportionate share of low-income individuals, with many lacking access to health care and health insurance. Health facilities are also comparatively fewer and more difficult to reach than in other areas of the United States. The impacts of this already poor health infrastructure on low-income people living with HIV in the South can be life-threatening.

This policy brief summarizes …

Understanding Hiv Care Delays In The Us South And The Role Of The Social-Level In Hiv Care Engagement/Retention: A Qualitative Study, Courtenay Sprague, Sara E. Simon

Center for Peace, Democracy and Development Publications

Introduction: In a significant geographical shift in the distribution of HIV infection, the US South - comprising 17 states - now has the greatest number of adults and adolescents with HIV (PLHIV) in the nation. More than 60% of PLHIV are not in HIV care in Alabama and Mississippi, contrasted with a national figure of 25%. Poorer HIV outcomes raise concerns about HIV-related inequities for southern PLHIV, which warrant further study. This qualitative study sought to understand experiences of low-income PLHIV on the AIDS Drug Assistance Program in engagement and retention in continuous HIV care in two sites in Alabama. …

"Choices" Florida's Version Of Obamacare, Jason Lamarr Wasden

UNLV Theses, Dissertations, Professional Papers, and Capstones

"CHOICES" Florida's version of ObamaCare was a unique case voted in by the public in Alachua County Florida. A mixed methods research design was utilized and provided context in which policy entrepreneurs operated, as well as an explanatory model of internal determinants. Social, economic and political factors were examined to determine the predictor variable in the adoption of the "CHOICES" health services program. The results revealed that voters 51 years of age and older had a greater probability of voting for the Alachua Referendum. "CHOICES" legality has not been under contention but its effectiveness has. This study found that "CHOICES" …

Influence Of The Patient Protection And Affordable Care Act On The Development Of The Patient Centered Medical Home, Anjali Rao

Master of Public Health Program Student Publications

The Patient Centered Medical Home (PCMH) model of care incorporates many public health concepts. Some supporters of PCMH regard the Affordable Care Act (ACA) as legislation that will invigorate PCMH progress across the country. This policy analysis intends to understand the influence of the ACA on the development of PCMH. The policy analysis compares relevant sections of the ACA with core PCMH concepts agreed upon by major medical professional organizations. The evaluative framework uses a “traffic light” system to rate each section of the ACA based on the accuracy of the section as compared to PCMH criteria, and denotes whether …

Understanding Underinsurance In Ohio, Meaghan Ebetino

Master of Public Health Program Student Publications

Objectives: To determine the prevalence, predictors, and consequences of underinsurance in the state of Ohio.

Study Design: The investigators created the dependent variables Underinsured, Financial Stress, and Harder to get Health Care using the 2008 Ohio Family Health Survey (OFHS). The sample used for this study included 29,778 respondents, who were adults less than 65 years old and who were continuously insured for the past 12 months.

Results: The study categorized twenty-two percent of the sample respondents as underinsured because they were not able to obtain or delayed needed medical care because of an inability to pay in …

Obesity: The Anthropometric And Demographic Characteristics Of Insured And Uninsured Individuals, Terra Fox Williams

Master of Public Health Program Student Publications

Objectives. This study evaluates the association between Body Mass Index (BMI) and health insurance status in attendees at a local health fair. BMI was also compared among ages, gender, and races.

Methods. Descriptive analysis conducted using data collected at the “Celebrating Life and Health” health fairs between the years 2008 and 2011. Data for this study were collected at the BMI booth staffed by Wright State Boonshoft School of Medicine students.

Results. The results of this particular study do not demonstrate a statistical difference between obesity and health insurance status. Consistent with other research articles this study does show that …

Unmet Medical Need Of Underserved Population In A Safety-Net Organization, Leslie Clem

Master of Public Health Program Student Publications

Background: Safety net providers serve a large proportion of America’s uninsured and low income population. The purpose of this study is to determine if differences in unmet medical needs exist between the provisional and clinic populations, age groups, and sex and race categories. This research study provides information about the population that receives services from Good Neighbor House, a non-profit social service organization in Dayton, Ohio.

Methods: GNH created a survey to assess the unmet medical need of their clients. The instrument contains questions about routine medical care, unmet medical care in the last 12 months, medical bills, and demographic …