Medicine and Health Sciences Commons^™

When A Health Insurance Provider Says “No”: A Health Insurance Claim Navigation Tool, Dorothy Nuckols, Catherine Sorenson

The Journal of Extension

The purpose of health insurance is to pay for preventative and nonpreventative health care. Unfortunately, claim denials are frequent and most people do not contested these denials. Consumers lack both knowledge and self-efficacy to challenge their health insurance decision. Conflict is stressful can occur when a health insurance claim is denied unexpectedly. Faced with uncertainty of health care cost coverage, consumers are more likely to delay or forgo healthcare and jeopardize their health. To address this challenge, increase awareness of claim appeal processes and to provide consumer guidance, [STATE] Extension developed a Health Insurance Claim Navigation Tool.

Insurance Status And Its Effect On Mothers With Postpartum Depression In The United States, Sanjana Davuluri, Lillian J. Alonzo, Nikita Paranjape, Akshad Thirugnanam, Alexander Youssef

Rowan-Virtua Research Day

Postpartum depression (PPD) is a significant health issue in the US today: 1 in 8 new mothers experience symptoms of PPD. Understanding how social determinants of health impact the short and long-term health outcomes of patients with PPD is key to providing interventions that are effective, efficient, equitable, and patient-centered. In this literature review, we aimed to shed light on the association between discrepancies in health outcomes of mothers with PPD and their insurance status. A search was conducted across PubMed and ProQuest Central databases focusing on literature from 2014 onwards. Studies that explored factors contributing to PPD, the impact …

Vulnerable Neighborhoods Had Smaller Gains In Health Insurance Coverage During Early Covid-19, Ismail Mustafa Aijazuddin, Ammar Sukari

Medical Student Research Symposium

Background:

The Covid-19 pandemic has illuminated the inequities that jeopardize health, prompting rapid interventions to promote care access. However, such efforts have had mixed success in eradicating disparities. One focus is the equity of improvements in insured rates.

Methods:

Self-reported health insurance coverage rates among adults aged 18-64 were obtained from the CDC’s PLACES datasets for collection years 2018 and 2021, at the Census Tract level. These data were merged with the CDC’s 2018 Social Vulnerability Index (SVI), which ranks Tracts on 15 measures of social determinants of health. Across Tracts nationally and by state, univariate correlations between Overall SVI …

Prior Authorizations And Addiction Treatment, Channie Cretsinger Mph, Jeremy C. Kourvelas Mph, Jennifer G. Tourville Dnp

SMART Policy Briefs

Key Points

• Concerns about prior authorizations have grown given research demonstrating inconsistent coverage and review policies across insurers, interruptions to care, high provider burden and higher healthcare costs.
• Tennessee policymakers and insurers have recently taken appropriate measures to ease the concerns and minizine unnecessary barriers. TennCare changed their policy on buprenorphine allowances in May 2023, essentially removing the prior authorization barrier for buprenorphine/naloxone preferred products.
• This is a significant step for Tennesseans given that the research shows that once the prior authorization process was removed for medications for opioid use disorder (MOUD), patients with opioid use disorder …

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 …

Self-Measured Blood Pressure Monitoring In Hypertension Control: The Role Of Social Determinants Of Health, Current State In The United States, And Future Directions, Adekunle Oke

Electronic Theses and Dissertations

Hypertension, a medical condition, predisposes to other cardiovascular diseases, and can be impacted by the social determinants of health (SDOH). Self-measured blood pressure monitoring (SMBP) is an evidence-based approach to hypertension control, but not much is known about the influence of SDOH on SMBP. This dissertation aims to: 1) highlight the SDOH factors whose relationship with SMBP have been explored in research studies; 2) examine the relationship between SDOH and SMBP among United States (U.S.) adults with high blood pressure; and 3) examine the current state of SMBP in the U.S., highlight policy implications from the empirical study and provide …

Factors Associated With Independent National Health Insurance Ownership Among Reproductive Aged Women In Indonesia, Ika Putri Widiarti, Haerawati Idris

Makara Journal of Health Research

Background: Indonesia has been aiming toward universal health coverage since 2019, but it has yet to be achieved. The National Health Insurance (NHI) program provides individual services for women of reproductive age who require health care before pregnancy, during pregnancy, and at the time of labor. This study aims to analyze factors associated with independent NHI ownership among women of reproductive age in Indonesia.

Methods: Secondary data from the Wave 5 Indonesia Family Life Survey (IFLS) involving 2,084 women of reproductive age were used. The chi-square test and logistic regression test were used for data analysis.

Results: …

Examining Newcomer Women’S Experiences With Perinatal Care In Ontario, Canada: An Application Of Carspecken’S Critical Ethnographic Method, Jessica Pimienta, Oona St-Amant, Sepali Guruge, Corinne Hart, Cristina Catallo

The Qualitative Report

This article provides a practical description of Carspecken’s (1996) five-stage critical ethnographic approach entitled “Critical Qualitative Research (CQR).” Situated epistemologically and ontologically in the critical paradigm, this article is an exploration of critical ethnography as an important methodology for shedding light on the discursive culture of perinatal care for newcomer women during the three-month health insurance waiting period in Ontario, Canada. We argue that Carspecken’s approach to critical ethnography is especially instrumental in illuminating the social structures that contribute to health inequities.

Unmet Healthcare Need Due To Cost Concerns Among U.S. Transgender And Gender-Expansive Adults: Results From A National Survey, Luisa Kcomt, Kevin M. Gorey, Betty Jo Barrett, Dana S. Levin, Jill Grant, Sean Esteban Mccabe

Social Work Publications

This study examines past-year unmet healthcare need due to cost experienced by transgender and gender-expansive (TGE) adults in the United States in the context of the Patient Protection and Affordable Care Act (ACA). It also aims to estimate the importance of having health insurance among TGE Americans (transgender men, transgender women, nonbinary/genderqueer people, and cross-dressers). Data were from the 2015 U.S. Transgender Survey (N ¼ 19,157 adults, aged 25 to 64 years). Multivariable logistic regression models were used to determine the adjusted odds ratios (AOR) and 95 percent confidence intervals (CI) of TGE individuals’ past-year unmet healthcare need due 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 …

Non-Elderly Adults On Disability In The Cf Population, Lea Nolan, Semret Seyoum, Julanne Wilson, Marsha Regenstein

Health Policy and Management Issue Briefs

No abstract provided.

An Examination Of Types Of Health Insurance And The Reported Prevalence Of Autism In The United States, Jennifer L. Thompson

Dissertations

The prevalence of Autism Spectrum Disorders continues to rise despite barriers of changes to diagnostic criteria and lack of insurance coverage. Increases in prevalence affect costs associated with a disorder since cost of health care services are often estimated based on utilization of services. This can also affect an individual’s ability to access to health care services. To equitably distribute autism services to individuals an accurate estimation of the true prevalence of autism is needed.

Access to health care can be influenced by the type of insurance coverage a person holds. Other factors, such as socio-economic status, ethnicity, location of …

National Health Insurance Program In Nepal: Early Experiences And Its Effect On Health Service Utilization, Rajani Bharati

Dissertations and Theses

Introduction: Nepal initiated the Health Insurance program in 2016 to achieve Universal Health Coverage by 2030. However, the enrollment rate is low, and people are already starting to drop out. Therefore, this study aimed to explore the demand and supply side (service providers) experiences with Nepal's National Health Insurance Program and its effect on insurance enrollment and health service utilization.

Methods: We employed a mixed-method design. Ethnographic methods were used to explore the rich holistic insights into people's views and actions. We conducted 14 focus group discussions and 20 key informant interviews, mainly in Kailali and Baglung districts. …

Health Belief Model Implications For Cervical Cancer Screening Among Refugee Women In Omaha, Nebraska, Na-Omi Hassane Dan Karami

Capstone Experience

Literature gap

According to the World Health Organization (2020), cervical cancer is among the top four most common cancers in women. However, refugee women are the least screened for cervical cancer. There is limited research examining the uptake of cervical cancer screenings among refugee women using the health belief model. Little is known about barriers and facilitators associated with the uptake of cervical cancer screening among refugee women in Nebraska.

Objectives:

The purpose of the study is to assess the health behavior of refugee women in Omaha towards cervical cancer screening via the health belief model and to determine the …

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. …

Risk Indicators Of Food Insecurity In The Cf Population, Semret Seyoum, Marsha Regenstein, Lea Nolan

Health Policy and Management Issue Briefs

No abstract provided.

Restriction Of Access To Deep Brain Stimulation For Refractory Ocd: Failure To Apply The Federal Parity Act, Rachel Davis, James Giordano, D Brian Hufford, Sameer A. Sheth, Peter Warnke, Alik S. Widge, R Mark Richardson, Joshua M. Rosenow, Peter Justin Rossi, Eric A. Storch, Helena Winston, Joanne Zboyan, Darin D. Dougherty, Kelly D. Foote, Wayne K. Goodman, Nicole C. Mclaughlin, Steven Ojemann, Steven Rasmussen, Aviva Abosch, Michael S. Okun

Faculty Publications

No abstract provided.

The Relationship Between Health Insurance Literacy, Health Insurance Coverage, And Health Insurance Utilization In The United States, Elizabeth Graves

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The Affordable Care Act (ACA) made health insurance more accessible but that does not mean that individuals understand their health insurance or are more confident in using it. The knowledge and confidence that individuals have in health insurance impact their health insurance literacy. Health insurance literacy (HIL) is defined as the ability and capacity to seek, obtain, understand, and potentially use health insurance information and plans.

This capstone study assesses how having HIL, which includes having a knowledge of health insurance terms and confidence in utilizing health insurance services, is related to having health insurance and having a usual source …

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 …

Cost, Coverage, And The Underuse Of Medications Among People With Cf, Semret Seyoum, Marsha Regenstein, Lea Nolan

Health Policy and Management Issue Briefs

No abstract provided.

Health Insurance Availability, Madison Shakespear

Sociology Student Work Collection

My presentation focuses on health insurance availability. Primarily, how much it costs and who is covered—or not covered—by third-party contributors (eg. employers). I also discuss the correlation between insurance-included benefits and higher education.

The Impact Of Medicare Insurance Plans Upon Healthcare Services Utilization Considering Patients' Characteristics And Their Access To Medical Care, Steven Stout

Dissertations

The annual average cost of healthcare for services utilization by a Medicare beneficiary is projected to grow from about $10,000 to over $16,000 by 2023. As an ongoing initiative to address this trend, the federal government contracts with private insurance companies and other entities, called Medicare Advantage Organizations (MAOs), to develop and administer alternative health insurance plans designed to contain service utilization and costs. One feature of some Medicare Advantage plans is the presence of risk-bearing contracts with primary care physician organizations that voluntarily accept financial responsibility for the overall cost of care for patients attributed to them. In this …

Egfr Testing And Erlotinib Use In Non-Small Cell Lung Cancer Patients In Kentucky, Kara L. Larson, Bin Huang, Quan Chen, Thomas C. Tucker, Marissa Schuh, Susanne M. Arnold, Jill M. Kolesar

Markey Cancer Center Faculty Publications

This study determined the frequency and factors associated with EGFR testing rates and erlotinib treatment as well as associated survival outcomes in patients with non small cell lung cancer in Kentucky. Data from the Kentucky Cancer Registry (KCR) linked with health claims from Medicaid, Medicare and private insurance groups were evaluated. EGFR testing and erlotinib prescribing were identified using ICD-9 procedure codes and national drug codes in claims, respectively. Logistic regression analysis was performed to determine factors associated with EGFR testing and erlotinib prescribing. Cox-regression analysis was performed to determine factors associated with survival. EGFR mutation testing rates rose from …

Health Is Wealth: The Correlation Of Wellness Programs & Productivity In Canada And The U.S., Madeline Wert

Business and Economics Summer Fellows

Does health impact the productivity of workers? Are there differences between the U.S. and Canada? Firms both in Canada and the U.S. deal with issues of presenteeism and absenteeism. Presenteeism is when an employee shows up to work but they are distracted by their own or a family member’s health issue. One response to reduce presenteeism and absenteeism are workplace wellness programs. Workplace wellness programs are facilitated programs by a firm to promote the health and wellbeing of their employees, which benefits the employer and the employees. There are additional incentives for U.S. employers to implement workplace wellness programs as …

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 …

Mhpaea & Marble Cake: Parity & The Forgotten Frame Of Federalism, Taleed El-Sabawi

Dickinson Law Review (2017-Present)

No abstract provided.

J Mich Dent Assoc February 2020

The Journal of the Michigan Dental Association

Every month,The Journal of the Michigan Dental Association brings news, information, and features about Michigan dentistry to our state's oral health community and the MDA's 6,200+ members. No publication reaches more Michigan dentists!

In this issue, the reader will find the following original content:

• A cover story on the 2020 MDA Annual Session
• A feature covering student perspectives on the Opioid Crisis
• News you need, Editorial and regular department articles on MDA Foundation activities, Dentistry and the Law, Staff Matters, Headquarters Report, and component news

This issue also includes articles reprinted with permission:

• “Muscle Deprogramming: A Source of Confusion”, …

The Impact Of The Fda Warning On Post-Tonsillectomy Opioid Prescribing In Publicly And Privately Insured Children, Dianna J. Soelberg

Theses and Dissertations

Due to reports of significant adverse events, the U.S. FDA placed a Boxed Warning on the opioid codeine in February 2013 – contraindicating its use in pediatric patients undergoing tonsillectomy and/or adenoidectomy. Studies conducted in privately insured children showed a reduction in codeine prescribing and a slight increase in alterative opioid prescribing following the FDA warning, yet the extent to which the FDA warning impacted prescribing in publicly insured children is unknown. Using a quasi-experimental interrupted time series design, this study evaluated codeine and alternative opioid prescribing before and after the FDA warning in both publicly and privately insured children …

The Association Of Health Insurance And Prescription Drug Coverage On Cost-Related Non-Adherence And Hospitalization Across Age-Related Groups Of Individuals With Copd, Shamika Martin Walls

Theses and Dissertations

Background: COPD patients have poor adherence to prescribed treatment. Individuals with COPD have higher out-of-pocket treatment cost than individuals without COPD. The significant out of pocket COPD related treatment cost can lead to prescription drug non-adherence especially for individuals without health insurance or prescription drug coverage.

Significance: Since the implementation of Medicare Part D on January 1, 2006, there are no studies that have used national data to evaluate the association of health insurance and prescription drug coverage on cost related non-adherence and hospitalization among individuals 50-64 years old with COPD compared to individuals 65 years and older …

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. …