Gis conf. 2013 differential effects of the great recession

240 views

Published on

Published in: Technology, Economy & Finance
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
240
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • Behavioral Risk Factor Surveillance SystemArea Resource File
  • Source: Solar O, Irwin A. A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion. Paper 2 (Policy and Practice).Available at: http://www.who.int/sdhconference/resources/ConceptualframeworkforactiononSDH_eng.pdf (Accessed 10.19.2012).
  • Gis conf. 2013 differential effects of the great recession

    1. 1. Differential Effects of The Great Recession onMinority Populations: Preliminary FindingsSamuel D. Towne Jr. MPH, CPHJanice C. Probst, PhDZhimin Chen, MSDepartment of Health Services Policy and ManagementArnold School of Public HealthFebruary 2013
    2. 2. Presenter Disclosures Samuel D. Towne, MPH, CPH The following personal financial relationshipswith commercial interests relevant to thispresentation existed during the past 12months:No relationships to disclose
    3. 3. Great RecessionThe United States (US) Bureau of Labor Statisticsdescribes an economic recession as:“A general slowdown in economic activity, adownturn in the business cycle, a reduction inthe amount of goods and serviced produced andsold” (US Bureau of Labor Statistics, p1, 2012a) December of 2007 and June of 2009 (USBureau of Labor Statistics (a), 2012).
    4. 4. State Policy Considerations As of July 2012, at least 13 states wereplanning to cut Medicaid in an attempt tobalance their budgets (Galewitz, 2012); (KaiserHealth News, 2012).
    5. 5. Medicaid Expansion Medicaid expansion: Broadening eligibility to include individualsnot previously eligible Associated with decreases in mortality ratesfor individuals in states that expandedeligibility (Sommers, 2012)
    6. 6. Medicaid Expansion New Medicaid enrollees under Section 1115Medicaid Waivers:Eligibility based on income category (%FPL) CharacteristicsOlder, minorities & those in poorer health thanthe general population (Sommers, 2012); (Natoli,2011)
    7. 7. Medicaid Expansion Section 1115 Expansion Enrollment,representing 37% of all Medicaid-coveredadults (Borck et al., 2012); (The MedicaidAnalytic Extract 2008 Chartbook AppendixTables For Chapter 7, p. 107, 2012)
    8. 8. Income Inequality Gini coefficients can be defined as:‘half of the arithmetic average of the absolutedifferences between all pairs of incomes in apopulation, the total then being normalized onmean income’ (Subramanian & Kawachi, p78,2004)
    9. 9. Patient Protection and Affordable Care Act(ACA) -2010Access (32 million newly covered) Medicaid ExpansionIndividuals < 133% Federal Poverty Level(FPL) Tax CreditsFamilies < 400% FPLGoal: Offset premiums & cost of insurancegained through State HI Exchanges
    10. 10. Race-Based Disparities -Education In 2009, White adults had the highest level ofeducation, with 90% having “at least a highschool education” (Ryan & Siebens, p. 5, 2012)Ryan CL, Siebens J (2012).
    11. 11. Race-Based Disparities -Employment American Indian and Alaska Native individualshad the “lowest labor force participationrates” (59.2%) of any race and ethnicity groupin 2011 Black individuals had the second lowest “laborforce participation rates” (61.4%) in 2011Source: (US Department of Labor and the US Bureau of LaborStatistics, p. 1, 2012)
    12. 12. Race-Based Disparities -Employment Hispanic workers were more likely to loseemployment-based health insurance coveragethan both Black and White individuals(Fronstin, 2012).
    13. 13. People without Health Insurance by Race and Ethnicity Group,2003 – 201115.80%21.00%17.20%32.40%0.00%5.00%10.00%15.00%20.00%25.00%30.00%35.00%40.00%200320042005200620072008200920102011WhiteBlackAsianHispanic of anyrace
    14. 14. Research Purpose Measure:Access & Utilization of Healthcare & HealthChanges across time (2003-2010) for racial &ethnic groups Identify Whether:Income InequalityMedicaid coverage policies affected individualsunevenly
    15. 15. Study Design & Population Cross-Sectional Samples, 2003-2010 Multi-level Models (Individuals nested withinStates) PopulationNon-institutionalized working-aged adults byrace/ethnicity DataBRFSS, ARF, Census
    16. 16. Conceptual Framework for Action on the SocialDeterminants of Health
    17. 17. • Public Policy• Medicaid Generosity (k)• Socioeconomic Position, SocialClass, Gender, Ethnicity, Education, Occupation, Income• Sex (i)• Income-level (i)• Race & Ethnic category (i)• Education-level (i)• Employment Status (i)• Insurance Coverage (i)• Age (i)StructuralDeterminants
    18. 18. • Material Circumstances• Median Income (j)• Income Inequality (Gini) (j)• Rurality(j)• Poverty Rate (j)• Unemployment Rate (j)• Behavioral & Biological factors• Disability (i)• Diabetes Status (i)IntermediaryDeterminants
    19. 19. • Self-reported Health Status• General Health Status• Poor Physical Health Days• Poor Mental Health Days• Access to Care• Cost-related Forgone MedicalCareImpact onEquity inHealth &Well-being
    20. 20. References U.S. Bureau of Labor Statistics. The Recession of 2007-2009. BLS Spotlighton Statistics. 2012 Feb: 1-18. Available at:http://www.bls.gov/spotlight/2012/recession/pdf/recession_bls_spotlight.pdf (Accessed December 16, 2012). Galewitz P, Fleming M. (2012). 13 states cut Medicaid to balance budgets.Kaiser Health News. July 24. Available at:http://www.kaiserhealthnews.org/Stories/2012/July/25/medicaid-cuts.aspx Kaiser Health News. (2012). States cutting Medicaid. July 24, Available at:http://www.kaiserhealthnews.org/Stories/2012/July/25/Medicaid-Cuts-Chart.aspx Sommers BD, Baicker K, Epstein AM. Mortality and Access to Care amongAdults after State Medicaid Expansions. N Engl J Med. 2012 Jul 25. [Epubahead of print]
    21. 21. References Natoli C, Cheh V, Verghese S (2011). Who will enroll in medicaid in 2014?Lessons from Section 1115 Medicaid Waivers. Mathematica PolicyResearch. Brief 1. May The Medicaid Analytic Extract (Max) 2008 Chartbook Appendix Tables ForChapter 7. Waiver Enrollment And Utilization. Table A7.1 Section 1115Waiver Enrollment In 2008. Available at: http://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/MedicaidDataSourcesGenInfo/MAX_Chartbooks.html (AccessedJanuary 29, 2013). Current Population Reports: Educational Attainment in the United States:2009: Population Characteristics. February 2012. Available at:http://www.census.gov/prod/2012pubs/p20-566.pdf (Accessed December16, 2012). US Department of Labor and the US Bureau of Labor Statistics. Labor ForceCharacteristics by Race and Ethnicity, 2007. Report 1005. September 2008.Available at: http://www.bls.gov/cps/cpsrace2007.pdf (AccessedDecember 16, 2012).
    22. 22. References DeNavas-Walt C, Proctor BD, Mills RJ. U.S. Census Bureau, Current PopulationReports, P60-226, Income, Poverty, and Health Insurance Coverage in the UnitedStates: 2003, U.S. Government Printing Office, Washington, DC, 2004. Availableat: http://www.census.gov/prod/2004pubs/p60-226.pdf (Accessed December16, 2012). DeNavas-Walt C, Proctor BD, Lee CH. U.S. Census Bureau, Current PopulationReports, P60-231, Income, Poverty, and Health Insurance Coverage in the UnitedStates: 2005, U.S. Government Printing Office, Washington, DC, 2006. Available at:http://www.census.gov/prod/2006pubs/p60-231.pdf (Accessed December16, 2012). DeNavas-Walt C, Proctor BD, Smith JC. U.S. Census Bureau, Current PopulationReports, P60-235, Income, Poverty, and Health Insurance Coverage in the UnitedStates: 2007, U.S. Government Printing Office, Washington, DC, 2008. Available at:http://www.census.gov/prod/2008pubs/p60-235.pdf (Accessed December16, 2012).
    23. 23. References DeNavas-Walt C, Proctor BD, Smith JC. U.S. Census Bureau, Current PopulationReports, P60-238, Income, Poverty, and Health Insurance Coverage in the UnitedStates: 2009, U.S. Government Printing Office, Washington, DC, 2010. Availableat: http://www.census.gov/prod/2010pubs/p60-238.pdf (Accessed December16, 2012). DeNavas-Walt C, Proctor BD, Smith JC. U.S. Census Bureau, Current PopulationReports, P60-239, Income, Poverty, and Health Insurance Coverage in the UnitedStates: 2010, U.S. Government Printing Office, Washington, DC, 2011. Availableat: http://www.census.gov/prod/2011pubs/p60-239.pdf (Accessed December16, 2012). DeNavas-Walt C, Proctor BD, Smith JC. U.S. Census Bureau, Current PopulationReports, P60-243, Income, Poverty, and Health Insurance Coverage in the UnitedStates: 2011, U.S. Government Printing Office, Washington, DC, 2012. Available at:http://www.census.gov/prod/2012pubs/p60-243.pdf (Accessed December16, 2012).
    24. 24. References Fronstin P. The impact of the recession on employment-basedhealth coverage. EBRI Issue Brief. 2010 May;(342):1-22. Subramanian SV, Kawachi I. (2004). Income inequality andhealth: what we have learned so far? Epidemiol Rev. 26(1):78-91 doi: 10.1093/epirev/mxh003

    ×