This document analyzes health insurance disparities related to labor factors in the Texas-Mexico border region. A logistic regression model using 2010 census data found that industries primarily employing the Mexican American population, such as construction and food services, were less likely to offer employer-based health insurance. Working in public sector industries or schools improved the probability of having employer-based insurance by 60% but these jobs were not highly represented among Mexican Americans. The findings provide evidence that labor factors play an important role in current health insurance access limitations within the Mexican American community under the Affordable Care Act, which focuses on small businesses and lower-income individuals.
This document discusses churning (involuntary movement between health insurance programs) under the Affordable Care Act. It aims to identify the characteristics of individuals likely to churn between Medicaid and Qualified Health Plans (QHPs), and the health plans best able to serve churning populations. The document introduces different types of health plans and examines their presence in several states' insurance exchanges. It outlines how churning will occur under the ACA and analyzes the experiences of Hawaii, New York, and Maryland to identify policies that can reduce churning, such as market alignment of insurers and strong data tools. The key findings are that market alignment dramatically reduces churning problems, data-driven health plans can help states address churning
DSmith_Increasing Health Insurance Literacy in Marketplaces and the Communiti...Denise Smith
This document discusses increasing health insurance literacy in marketplaces and communities. It begins with background on health insurance marketplaces established under the Affordable Care Act and defines the problem of low health insurance literacy hindering enrollment and access to care. The literature review discusses integrating health literacy education into adult education programs and organizations addressing health literacy as a priority to improve access.
DSmith_Increasing Health Insurance Literacy in Marketplaces and the Communiti...Denise Smith
This document discusses increasing health insurance literacy in marketplaces and communities. It begins with background on health insurance marketplaces established under the Affordable Care Act and defines the problem of low health insurance literacy hindering enrollment and access to care. The literature review discusses integrating health literacy education into adult education programs and organizations addressing health literacy as a priority.
Health System Analysis- Mexico and the United StatesAndrew Nelson
This document provides an overview and comparison of the health systems in Mexico and the United States, with a focus on obesity. It describes key differences between the two systems, such as Mexico having a predominantly public system while the US has a mixture of public and private. It also discusses challenges each system faces in controlling obesity, like the US lacking comprehensive prevention mechanisms and Mexico having infrastructure issues. The document aims to analyze how each country can address obesity within their respective health systems.
ORIGINAL PAPER‘‘They Treat you a Different Way’’ Public I.docxvannagoforth
The document summarizes a study examining experiences of stigma among low-income public insurance beneficiaries in Michigan. Key findings include:
1) Participants reported experiencing stigma in healthcare settings through poor quality care and negative interactions with providers, which they attributed to their public insurance status.
2) The stigma of public insurance was compounded by other sources of stigma such as socioeconomic status, race, gender, and illness, highlighting how multiple forms of stigma can intersect.
3) Experiences of stigma had consequences for how participants evaluated care quality, continuity of care, and ability to access healthcare.
ORIGINAL PAPER‘‘They Treat you a Different Way’’ Public I.docxhoney690131
ORIGINAL PAPER
‘‘They Treat you a Different Way:’’ Public Insurance,
Stigma, and the Challenge to Quality Health Care
Anna C. Martinez-Hume1 • Allison M. Baker2 •
Hannah S. Bell
1
• Isabel Montemayor
3
•
Kristan Elwell4 • Linda M. Hunt1
Published online: 26 December 2016
� Springer Science+Business Media New York 2016
Abstract Under the Affordable Care Act, Medicaid Expansion programs are
extending Medicaid eligibility and increasing access to care. However, stigma
associated with public insurance coverage may importantly affect the nature and
content of the health care beneficiaries receive. In this paper, we examine the health
care stigma experiences described by a group of low-income public insurance
beneficiaries. They perceive stigma as manifest in poor quality care and negative
interpersonal interactions in the health care setting. Using an intersectional
approach, we found that the stigma of public insurance was compounded with other
sources of stigma including socioeconomic status, race, gender, and illness status.
Experiences of stigma had important implications for how subjects evaluated the
quality of care, their decisions impacting continuity of care, and their reported
ability to access health care. We argue that stigma challenges the quality of care
provided under public insurance and is thus a public health issue that should be
addressed in Medicaid policy.
Keywords Stigma � Insurance � Poverty � Healthcare � Medicaid �
Intersectionality
& Linda M. Hunt
[email protected]
1
Department of Anthropology, Michigan State University, 355 Baker Hall, 655 Auditorium
Drive, East Lansing, MI 48824, USA
2
Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Avenue,
Boston, MA 02115, USA
3
Department of Sociology and Anthropology, University of Texas at Arlington, 430 University
Hall, 601 S. Nedderman Drive, Arlington, TX 76019, USA
4
Center for Health Equity Research, Northern Arizona University, 1100 S. Beaver St., Flagstaff,
AZ 86011, USA
123
Cult Med Psychiatry (2017) 41:161–180
DOI 10.1007/s11013-016-9513-8
http://orcid.org/0000-0002-1214-8569
http://crossmark.crossref.org/dialog/?doi=10.1007/s11013-016-9513-8&domain=pdf
http://crossmark.crossref.org/dialog/?doi=10.1007/s11013-016-9513-8&domain=pdf
Introduction
A key feature of the Affordable Care Act is Medicaid Expansion, which extends
Medicaid eligibility to many low-income adults with the goal of improving health
equity through increased access to care. While addressing an urgent public health
need, issues within the social context of public insurance may diminish the success
of such programs in effectively addressing health disparities. One such concern is
stigma associated with public insurance coverage, including Medicaid and other
state-sponsored programs for the low-income, which may meaningfully affect the
nature and content of health care.
Stigma—the negative experience of stereotyping, labeling, e.
The document discusses the Affordable Care Act (ACA) and its impact on socioeconomic inequality from an interdisciplinary perspective. It analyzes the ACA through the lenses of economics, political science, and communication. While the ACA aims to expand access to healthcare, it has also increased costs and reduced access for some. There are also issues with unclear communication about the ACA and lack of cooperation from some state governments in implementing aspects of the law. The document argues that an interdisciplinary approach is needed to fully understand and address the complex problems posed by the ACA.
The student writes a letter to an honorable Simon bringing attention to the pressing issue of rising healthcare costs among elderly Hispanic Americans in the region. This is impacting individuals' health and families' financial stability as well as the overall economy. The student urges the honorable Simon to take action by prioritizing policies that improve healthcare affordability, access, and equity for this group. Addressing the issue could significantly reduce costs for healthcare organizations and taxpayers while improving individuals' health outcomes.
This document discusses churning (involuntary movement between health insurance programs) under the Affordable Care Act. It aims to identify the characteristics of individuals likely to churn between Medicaid and Qualified Health Plans (QHPs), and the health plans best able to serve churning populations. The document introduces different types of health plans and examines their presence in several states' insurance exchanges. It outlines how churning will occur under the ACA and analyzes the experiences of Hawaii, New York, and Maryland to identify policies that can reduce churning, such as market alignment of insurers and strong data tools. The key findings are that market alignment dramatically reduces churning problems, data-driven health plans can help states address churning
DSmith_Increasing Health Insurance Literacy in Marketplaces and the Communiti...Denise Smith
This document discusses increasing health insurance literacy in marketplaces and communities. It begins with background on health insurance marketplaces established under the Affordable Care Act and defines the problem of low health insurance literacy hindering enrollment and access to care. The literature review discusses integrating health literacy education into adult education programs and organizations addressing health literacy as a priority to improve access.
DSmith_Increasing Health Insurance Literacy in Marketplaces and the Communiti...Denise Smith
This document discusses increasing health insurance literacy in marketplaces and communities. It begins with background on health insurance marketplaces established under the Affordable Care Act and defines the problem of low health insurance literacy hindering enrollment and access to care. The literature review discusses integrating health literacy education into adult education programs and organizations addressing health literacy as a priority.
Health System Analysis- Mexico and the United StatesAndrew Nelson
This document provides an overview and comparison of the health systems in Mexico and the United States, with a focus on obesity. It describes key differences between the two systems, such as Mexico having a predominantly public system while the US has a mixture of public and private. It also discusses challenges each system faces in controlling obesity, like the US lacking comprehensive prevention mechanisms and Mexico having infrastructure issues. The document aims to analyze how each country can address obesity within their respective health systems.
ORIGINAL PAPER‘‘They Treat you a Different Way’’ Public I.docxvannagoforth
The document summarizes a study examining experiences of stigma among low-income public insurance beneficiaries in Michigan. Key findings include:
1) Participants reported experiencing stigma in healthcare settings through poor quality care and negative interactions with providers, which they attributed to their public insurance status.
2) The stigma of public insurance was compounded by other sources of stigma such as socioeconomic status, race, gender, and illness, highlighting how multiple forms of stigma can intersect.
3) Experiences of stigma had consequences for how participants evaluated care quality, continuity of care, and ability to access healthcare.
ORIGINAL PAPER‘‘They Treat you a Different Way’’ Public I.docxhoney690131
ORIGINAL PAPER
‘‘They Treat you a Different Way:’’ Public Insurance,
Stigma, and the Challenge to Quality Health Care
Anna C. Martinez-Hume1 • Allison M. Baker2 •
Hannah S. Bell
1
• Isabel Montemayor
3
•
Kristan Elwell4 • Linda M. Hunt1
Published online: 26 December 2016
� Springer Science+Business Media New York 2016
Abstract Under the Affordable Care Act, Medicaid Expansion programs are
extending Medicaid eligibility and increasing access to care. However, stigma
associated with public insurance coverage may importantly affect the nature and
content of the health care beneficiaries receive. In this paper, we examine the health
care stigma experiences described by a group of low-income public insurance
beneficiaries. They perceive stigma as manifest in poor quality care and negative
interpersonal interactions in the health care setting. Using an intersectional
approach, we found that the stigma of public insurance was compounded with other
sources of stigma including socioeconomic status, race, gender, and illness status.
Experiences of stigma had important implications for how subjects evaluated the
quality of care, their decisions impacting continuity of care, and their reported
ability to access health care. We argue that stigma challenges the quality of care
provided under public insurance and is thus a public health issue that should be
addressed in Medicaid policy.
Keywords Stigma � Insurance � Poverty � Healthcare � Medicaid �
Intersectionality
& Linda M. Hunt
[email protected]
1
Department of Anthropology, Michigan State University, 355 Baker Hall, 655 Auditorium
Drive, East Lansing, MI 48824, USA
2
Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Avenue,
Boston, MA 02115, USA
3
Department of Sociology and Anthropology, University of Texas at Arlington, 430 University
Hall, 601 S. Nedderman Drive, Arlington, TX 76019, USA
4
Center for Health Equity Research, Northern Arizona University, 1100 S. Beaver St., Flagstaff,
AZ 86011, USA
123
Cult Med Psychiatry (2017) 41:161–180
DOI 10.1007/s11013-016-9513-8
http://orcid.org/0000-0002-1214-8569
http://crossmark.crossref.org/dialog/?doi=10.1007/s11013-016-9513-8&domain=pdf
http://crossmark.crossref.org/dialog/?doi=10.1007/s11013-016-9513-8&domain=pdf
Introduction
A key feature of the Affordable Care Act is Medicaid Expansion, which extends
Medicaid eligibility to many low-income adults with the goal of improving health
equity through increased access to care. While addressing an urgent public health
need, issues within the social context of public insurance may diminish the success
of such programs in effectively addressing health disparities. One such concern is
stigma associated with public insurance coverage, including Medicaid and other
state-sponsored programs for the low-income, which may meaningfully affect the
nature and content of health care.
Stigma—the negative experience of stereotyping, labeling, e.
The document discusses the Affordable Care Act (ACA) and its impact on socioeconomic inequality from an interdisciplinary perspective. It analyzes the ACA through the lenses of economics, political science, and communication. While the ACA aims to expand access to healthcare, it has also increased costs and reduced access for some. There are also issues with unclear communication about the ACA and lack of cooperation from some state governments in implementing aspects of the law. The document argues that an interdisciplinary approach is needed to fully understand and address the complex problems posed by the ACA.
The student writes a letter to an honorable Simon bringing attention to the pressing issue of rising healthcare costs among elderly Hispanic Americans in the region. This is impacting individuals' health and families' financial stability as well as the overall economy. The student urges the honorable Simon to take action by prioritizing policies that improve healthcare affordability, access, and equity for this group. Addressing the issue could significantly reduce costs for healthcare organizations and taxpayers while improving individuals' health outcomes.
1 3Defining the ProblemRigina CochranMPA593August 1.docxsmithhedwards48727
1
3Defining the Problem
Rigina CochranMPA/593
August 19, 2019
Peter ReevesDefining the Problem
The health care system in Colorado is a composition of medical professionals providing services such as diagnosis, treatment, as well as preventive measures to mental illness and injuries ("Healthcare policy in Colorado - Ballotpedia," 2019). Health care policy involves the establishment and implementation of legislation and other regulations that the states use to manage its health care system effectively. Further, this sector consists of other participants, such as insurance and health information technology. The cost citizens pay for medical care and also the access to quality care influence the overall health care providers in Colorado. Therefore, the need for the creation and implementation of laws that help the state maintain efficiency in the health sector in Colorado.
Problem Statement
The declining standards of medical care within the United States has caused significant concern in the world. Due to these rising concerns, there have been various policies implemented, leading to mixed reactions among the different states. Some of the active policies implemented offer a long-term solution to this problem including Medicaid and Medicare. After acquiring state control, the Republicans dismissed the idea to expand and create medical insurance for Medicaid in Colorado. Sustaining the structure of the health care payroll calls for the deductions from the employees and the employers, which may lead to loss of jobs and increased burden of expenditure (Garcia, 2019).
Identify the Methodology
The main objective of this policy plan is to investigate the role of legislation in the management of the health care sector in the United States. Due to the need for achieving in-depth exploration, this paper uses a combination of both qualitative and quantitative methods of data collection by addressing both practical and theoretical aspects of the research. Based on the answers that the policy requires, choosing survey as the research design. This method involves collecting and analyzing data from a few people who represent the principal group within health care. However, the survey method faces some challenges such as attitudes and perception of the health workers leading to the delimitation of the study. The target population for the study includes the nurses within the health sectors in Colorado. The selection of the participants involved in the use of stratified random sampling.
Identify your Stakeholders
The major stakeholders in the creation and implementation of the policy plan include the legislatures, local government, patients, and other private parties such as the insurance companies. Collectively, these bodies are involved in the making of thousands of decisions, overseeing hospitals, making budgetary appropriations, assisting the health workers to acquire licenses, determination of services that the insurers cover, and the management of.
April 2011In the fall of 2010, the Alliance for Health R.docxjewisonantone
April 2011
In the fall of 2010, the Alliance for Health
Reform, with support from the Robert
Wood Johnson Foundation, held a series of
Capitol Hill briefings on issues pertaining to
the health care workforce. The first brief-
ing in the series examined the physician
workforce. It looked at supply and demand
issues that may be changing as a result
of health reform. Panelists were: Edward
Salsberg, National Center for Workforce
Analysis, HRSA; Thomas Ricketts, Cecil G.
Sheps Center for Health Services Research,
University of North Carolina at Chapel Hill;
and Jay Crosson of the Kaiser Permanente
Institute for Health Policy. The second
briefing focused on nurses, allied health
professionals, direct care workers and the
various provisions of the health reform law
pertaining to them. Panelists were: Joel
Teitelbaum, George Washington University;
Bob Konrad, Cecil G. Sheps Center; Linda
Burnes Bolton, Cedars-Sinai Medical Center
and Catherine Dower, University of Califor-
nia, San Francisco.
Health Care Workforce:
Future Supply vs. Demand
Physician and nursing shortages
make headline news on a regular
basis. Debates continue in policy
circles among researchers, analysts
and stakeholders on whether the
shortages are due to insufficient
numbers of providers, or maldistri-
bution of those providers.
Experts also debate over whether
the solutions are to build more
schools and enlarge classes to
graduate more physicians, expand
the number of residency slots, find
incentives to attract providers to
health professional shortage areas,
or change the way we deliver care.
We begin to see the complexity of
analyzing the problem and matching
the solutions to the challenges if we
also consider:
• Is there an adequate and efficient
ratio of primary care providers to
specialists?
• Are we training for the right skills?
• Are those with skills using them to
their maximum potential?
• Where do nurses and licensed and
unlicensed allied health profession-
als fit into the picture?
Some key factors affecting
the adequacy of the health
care workforce include
growth in the insured
population as a result of the
health reform law, an aging
U. S. population, an aging
health care workforce, the
Fast Facts
n 40 percent of practicing physicians are older than 55; about one-third of
the nursing workforce is over age 50.
n Economists say a third of physicians could retire in the next 10 years.
n More than half of nurses over 50 say they plan to retire in the next de-
cade.
n Team-based care and an expanded role for advance practice nurses and
physician assistants could mitigate the shortage of primary care providers.
n The Institute of Medicine recommended, in October 2010, that nurses be
allowed to practice to the full extent of their education and training. Cur-
rently only eleven states allow nurse practitioners to practice independent
of a physician.
n Student medical school debt averages $.
April 2011In the fall of 2010, the Alliance for Health R.docxjustine1simpson78276
April 2011
In the fall of 2010, the Alliance for Health
Reform, with support from the Robert
Wood Johnson Foundation, held a series of
Capitol Hill briefings on issues pertaining to
the health care workforce. The first brief-
ing in the series examined the physician
workforce. It looked at supply and demand
issues that may be changing as a result
of health reform. Panelists were: Edward
Salsberg, National Center for Workforce
Analysis, HRSA; Thomas Ricketts, Cecil G.
Sheps Center for Health Services Research,
University of North Carolina at Chapel Hill;
and Jay Crosson of the Kaiser Permanente
Institute for Health Policy. The second
briefing focused on nurses, allied health
professionals, direct care workers and the
various provisions of the health reform law
pertaining to them. Panelists were: Joel
Teitelbaum, George Washington University;
Bob Konrad, Cecil G. Sheps Center; Linda
Burnes Bolton, Cedars-Sinai Medical Center
and Catherine Dower, University of Califor-
nia, San Francisco.
Health Care Workforce:
Future Supply vs. Demand
Physician and nursing shortages
make headline news on a regular
basis. Debates continue in policy
circles among researchers, analysts
and stakeholders on whether the
shortages are due to insufficient
numbers of providers, or maldistri-
bution of those providers.
Experts also debate over whether
the solutions are to build more
schools and enlarge classes to
graduate more physicians, expand
the number of residency slots, find
incentives to attract providers to
health professional shortage areas,
or change the way we deliver care.
We begin to see the complexity of
analyzing the problem and matching
the solutions to the challenges if we
also consider:
• Is there an adequate and efficient
ratio of primary care providers to
specialists?
• Are we training for the right skills?
• Are those with skills using them to
their maximum potential?
• Where do nurses and licensed and
unlicensed allied health profession-
als fit into the picture?
Some key factors affecting
the adequacy of the health
care workforce include
growth in the insured
population as a result of the
health reform law, an aging
U. S. population, an aging
health care workforce, the
Fast Facts
n 40 percent of practicing physicians are older than 55; about one-third of
the nursing workforce is over age 50.
n Economists say a third of physicians could retire in the next 10 years.
n More than half of nurses over 50 say they plan to retire in the next de-
cade.
n Team-based care and an expanded role for advance practice nurses and
physician assistants could mitigate the shortage of primary care providers.
n The Institute of Medicine recommended, in October 2010, that nurses be
allowed to practice to the full extent of their education and training. Cur-
rently only eleven states allow nurse practitioners to practice independent
of a physician.
n Student medical school debt averages $.
Summarize Competing Agendas for Healthcare Reform.pdfsdfghj21
The document discusses competing agendas for healthcare reform in the United States. It identifies individual and community barriers that contribute to inequitable access to Medicaid programs and services, such as race, income, education level, insurance status, and neighborhood factors. The Patient Protection and Affordable Care Act aims to address these issues by expanding Medicaid eligibility, funding new programs, and reducing barriers to healthcare access. However, state decisions to opt out of Medicaid expansion and federal budget cuts threaten to undermine some of the Affordable Care Act's efforts. The document also analyzes debates around the roles of the federal government, states, and private insurers in reforming the U.S. healthcare system.
This study is to focus attention on the extent to which the health care needs of
adolescents and young adults are being planned for and addressed as New York implements the Patient
Protection and Affordable Care Act (ACA)
According to this idea that gender is socially constructed, answer.docxronak56
According to this idea that gender is socially constructed, answer the following questions:
1. What does it mean to be a man in the U.S.? What does it mean to be a woman?
2. From what institutions do we learn these gender roles?
3. How do these clips demonstrate the ways in which gender is socially constructed in the U.S.? Do the concepts discussed in the clips resonate with you? Why or why not?
In Persepolis, the main character Marji struggles to define her identity as an Iranian woman in a changing society.
· What roles are depicted for women in Iranian society in the film? How do they change over time?
· How does Persepolis demonstrate the ways in which gender and identity are influenced in many ways, by different processes across cultures? How are gender roles in Iran similar, or different to gender in the U.S.?
· What are some of the stereotypes that exist about Muslim women and how does Abu-Lughod in “Do Muslim Women Need Saving” and Persepolis complicate these stereotypes?
Answer the following questions 2 full pages
Running head: MAJOR HEALTH CARE PROBLEMS IN THE U.S. 1
Major Health Care Problems in the U.S.
Jane Doe
ID: 1212121
MAJOR HEALTH CARE PROBLEMS IN THE U.S. 2
Major Health Care Problems in the US
Problem statement: High and continuously rising cost of health care has been and still is one of
the biggest challenges affecting the Health Care system in United States.
Methods of Examining the Problem
Both qualitative and quantitative research methods should be used to fully understand the
issue of high cost of care in the US. Quantitative methods like surveys and experimentations will
aid in estimating the prevalence, magnitude and frequency of the problem in different regions.
On the other hand, qualitative methods like case studies and observation will help describe the
extent and complexity of the issue. The two approaches need to work in complementation to
obtain a clear understanding of this menace.
Surveys, as a quantitative research method, is one of the most effective in the social
research and present a more viable method of examining the cost of health in the country. They
involve asking of questions in the form of questionnaires and interviews. Questionnaires are
written questions to which the response can be open ended or multiple-choice format. This
would be used to gain information about cost within determinants that are of
disagree/neutral/agree nature. An example is if patients are contented with the cost of services
they get or they deem the cost of cover worthy. Interviews, the researcher discussing issues with
the respondents, are to be used to gain more details on already known aspects of the system. This
may include gathering information to inform policies, administration and use of technology to
minimize the cost of care.
Since health cost in the US is not a new challenge and there have been studies about it,
qualitative methods like .
Report IIShawnette Jones MHA507Rea Burleson .docxaudeleypearl
Report II
Shawnette Jones
MHA/507
Rea Burleson
University of Phoenix
10/06/2019
Since the location of the highest widespread virus outbreaks have been recognized, it is important to know now what age group is mostly affected by the virus. Documenting these given age groups shall assist to determine the kinds of resources which shall be necessary at these locations to correctly treat these patients.
Age Groups Most Affected
Following the World Health Organization (2019) show that children, pregnant women and adults are particularly the ones who are vulnerable and take a relatively biggest share of the diseases load. The analysis of the given information, show that the progression of the age group most affected starting with the highest are under 18,61 and over 31-60 and finally 19-30 that correspond to the research of the World Health Organization on most vulnerable groups of individuals.
Age Groups Least Affected
The age groups least affected are the 19-30 years old in addition to those under 31- 60 years old. Generally, this kind of group comprises of the young adults as well as individuals in their middle ages. The reason why this group is probably least affected is due to the fact that this age brackets the body immune system is possibly more strong in preventing and fighting infections thus making the individual much healthier (Lesourd & Meaume, 1994).
Bar Graph Showing Ages Affected
Chart Evaluation
The bar graph above illustrates that the least age groups affected are ones between 19 to 30 years old. According to Morse (2001) explain that the observed age outlines can impact after intolerance diagnosing, identifying as well as cases recording, changes in exposure as well as variances invulnerability to the virus. Therefore by determining if change with age is contingent on exposure or vulnerability requires an evaluation of exposures in individual with and without the illness. Individual influences results to virus occurrences that can be recognized in nearly all incidents.
Prevalence Rates
The prevalence rate for this disease changes among the diverse age groups in every city. According to United States Census Bureau (2017) explanation the current population of the United States of America is 325,365,189 as of December 18, 2017. Therefore to determine the prevalence rate per 100,000 for this disease equals, the number of infection in the particular age group divided by the United States population, then multiplied by 100,000.
The following chart shows the prevalence rate for each age group in each of the top five cities affected by this disease.
City
<18 Prevalence Rate
19-30 Prevalence Rate
31-60 Prevalence Rate
61+ Prevalence Rate
Jacksonville
0.02858
0.00584
0.01875
0.04579
Miami
0.05225
0.00553
0.00922
0.02490
Phoenix
0.04457
0.00615
0.00984
0.02828
Austin
0.04641
0.00369
0.01199
0.02428
Houston
0.03012
0.00492
0.01598
0.03258
Conclusion
Finally, the study of age groups that are mainly affected and vulnera ...
Respond to at least two classmates who identified different areas of.docxpeggyd2
Respond to at least two classmates who identified different areas of disparity than your own. Do you agree or disagree with their assessment of the impact of economic policy on the disparity? Does the disparity discussed have a microeconomic or a macroeconomic impact on health care?
Post # 1
Trina Cox
Disparity in healthcare can be defined as, “differences between groups in health insurance coverage, access to and use of care, and quality of care” (Orger & Artiga, 2018). There are various healthcare disparities; however, the key areas of disparity I have chosen to identify and analyze include health insurance coverage, quality of care, and gender. As most people already know, health insurance is a type of insurance coverage that is designed to cover an insured person’s medical expenses (such as hospital, doctor, laboratory and pharmacy services). Although the number of uninsured Americans have decreased drastically since the passing of ACA, disparities in this area still exist. Some individuals’ annual incomes still are not enough to pay the low premiums that may be required of them to have access to health insurance coverage.
Quality of care can be described as, “the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (AHRQ, 2017). Although it is an unethical act displayed by healthcare professionals; in some areas, all patients are not treated equally with regards to quality of care. According to Dr. Ananya Mandal (2019), discrimination occurs when healthcare providers treat individuals from certain population groups differently to other population groups, whether this is done consciously or not. It is common for this to occur when providers have stereotyped impressions of specific racial or ethnic groups.
Gender can play a major role in healthcare disparities among women, specifically, in some of the developed countries. Researchers have reported that determinants of gender differences, like welfare indicators (e.g., education and income), behavioral factors (e.g., smoking and drinking), and social factors (e.g., social support and socioeconomic status) have direct correlations with some of the existing disparities (Hassanzadeh, et al, 2017). Afghanistan is a country that still has a high rate of gender disparities among women, even though some improvements have occurred. In this country, the biggest disparities that I feel still exist are between women in rural versus urban areas, and those with some education, as opposed to those women with none; showing that as education of women increases, so does their health and that of their children because of the education and resources that they have.
I think several economic policies have impacted these disparities and they include differences in income levels, education, and geographic location. A person’s annual income may have a direct effect on his or her ability.
This document discusses a data analysis task involving childhood obesity rates in different regions of the United States. The analysis will use data on the percentage of overweight and obese children ages 10-17 in each state. The states will be categorized into regions - East, South, Midwest, and West. A cluster analysis technique will be used to determine if there are trends in childhood obesity rates between different regions. If trends are found, government and healthcare organizations can focus obesity prevention programs on specific regions. The document provides background on the situation, data sources, and analysis methodology to be used.
1
Literature Review Assignment
STUDENT NAME
Class
Date
2
Part A: Annotated Bibliography
Article 1: Immigration as a Social Determinant of Health
Castañeda, H., Holmes, S. M., Madrigal, D. S., Young, M.-E. D., Beyeler, N., & Quesada, J.
(2015). Immigration as a Social Determinant of Health. Annual Review of Public
Health, 36(1), 375–392. doi: 10.1146/annurev-publhealth-032013-182419
Abstract
Although immigration and immigrant populations have become increasingly important foci in
public health research and practice, a social determinants of health approach has seldom been
applied in this area. Global patterns of morbidity and mortality follow inequities rooted in
societal, political, and economic conditions produced and reproduced by social structures,
policies, and institutions. The lack of dialogue between these two profoundly related
phenomena—social determinants of health and immigration—has resulted in missed
opportunities for public health research, practice, and policy work. In this article, we discuss
primary frameworks used in recent public health literature on the health of immigrant
populations, note gaps in this literature, and argue for a broader examination of immigration as
both socially determined and a social determinant of health. We discuss priorities for future
research and policy to understand more fully and respond appropriately to the health of the
populations affected by this global phenomenon.
Annotated Bibliography
The article reports on the importance of identifying social determinants and the effects of
socially determined structures among immigrant populations in the United States. The study
identifies ways in which immigrants health outcomes are based on biases due to using
3
information based on group behaviors instead of on an induvial case. The impact of migrant and
immigrant individuals, physical and mental health in these communities’ changes as social,
economic, and political policies take place. This article is helpful in that broadens the
immigration experience including more central factors than just language, income, or education
as the cause of all health related problems in this community. But to show factors of power
structures and the ability to put in place effective health interventions that respond to direct
causes of poor or declining health in these populations.
Article 2: Fear by Association: Perceptions of Anti-Immigrant Policy and Health Outcomes
Vargas, Edward & Sanchez, Gabriel & Juárez, Melina. (2017). Fear by Association: Perceptions
of Anti-Immigrant Policy and Health Outcomes. Journal of Health Politics, Policy and
Law. 42. 3802940. 10.1215/03616878-3802940.
Abstract
The United States is experiencing a renewed period of immigration and immigrant policy
activity as well as heightened enforcement of such policies. This intensified activity can affect
various aspects of im ...
The document summarizes the historical transition and growth of the U.S. health care system from the 19th century to present day. It discusses key milestones like the establishment of private health insurance in the 1930s and government programs Medicare and Medicaid in 1965. Major changes included the rise of HMOs in the 1980s and an increased focus on preventative care and reducing costs. The paper also examines challenges facing the system like an aging population as baby boomers require more care and changing demographics bringing new diseases. Financing and technology are seen as important factors enabling advancement, but affordability remains a challenge given high expenditures in the U.S. system.
This document describes a proposed randomized controlled trial to test the effectiveness of a health literacy and community health worker intervention for type 2 diabetes patients in community health centers. The study aims to address the gap in knowledge about how such interventions impact clinical outcomes like adherence, self-management, and communication. If shown to be effective, the intervention could help the millions of Americans with limited health literacy better manage their chronic conditions. The trial would involve community health centers in low-income neighborhoods of Boston serving predominantly minority populations disproportionately impacted by diabetes complications. Results could demonstrate cost-effective ways to incorporate health literacy and community health workers into standard care for medically underserved groups.
This document describes a study that examined how unmet basic needs cluster in low-income populations and how the effectiveness of health interventions may vary based on levels of unmet basic needs. The study analyzed data from a randomized controlled trial where low-income callers to a 211 helpline received cancer screening referrals along with one of three interventions: verbal referral only, verbal referral plus a printed reminder, or verbal referral plus navigation from a health coach. Latent class analysis identified three classes of unmet basic needs among participants. Logistic regression found that for those with relatively more or money-specific unmet needs, the navigator intervention was more effective at linking them to health referrals, while the printed reminder worked as well as the navigator for those
HCS 410(2) ACA Tittle IV-Prevention of Chronic diseasesMaria Jimenez
The document summarizes key aspects of the Affordable Care Act as it relates to prevention and wellness. It describes how the ACA aims to promote prevention, fund public health initiatives, and reduce chronic disease. It discusses provisions such as banning pre-existing condition exclusions, covering preventive services with no cost sharing, and investing in community-based prevention programs. However, it also notes that Republicans questioned whether these prevention initiatives were worth funding.
The December edition of the Professional Diversity Network Jobs Index & Report focuses on the Healthcare sector and the position of the diverse employee and candidate in this rapidly growing segment of the US economy.
DSmith_Increasing Prevention Utilization among African Americans_The_6_18_App...Denise Smith
This document provides a literature review and proposes a system-level solution to increase utilization of preventive services among African Americans. It summarizes approaches at the individual, provider, and system levels. At the system level, it advocates for the Centers for Disease Control and Prevention's 6|18 Initiative, which aims to rapidly adopt evidence-based interventions for six high-burden conditions disproportionately impacting African Americans through alignment of public health, clinical care, payers and providers. The initiative has potential to benefit millions of African Americans covered by Medicare and Medicaid.
DSmith_Increasing Prevention Utilization among African Americans_The 6 18 App...Denise Smith
This document provides an overview of approaches to increase the utilization of preventative services among African Americans, including interventions at the individual, provider, and system levels. It discusses challenges with purely individual behavioral change approaches, such as a lack of consideration for social determinants of health. At the provider level, value-based payment models that incentivize high-value preventative care show promise but face issues around a lack of consensus on what constitutes "value" and a need for more research on interventions proven to benefit African Americans specifically. The document argues that a system-level intervention like the CDC's 6|18 Initiative, which identifies high-burden preventable conditions affecting African Americans and coordinates public health prevention resources, shows the most promise
The document discusses key issues with the American healthcare system by analyzing three important exhibits. Exhibit 2 shows that while the US scores well on health outcomes, it performs poorly on access and efficiency compared to other countries. Exhibit 3 illustrates how the US spends nearly twice as much on healthcare than other nations without better quality. Exhibit 13 highlights the problem of nearly 47 million uninsured Americans lacking access to healthcare. Overall, the exhibits show the US healthcare system struggles with access, costs, and quality despite high spending, indicating managerial issues more than financial constraints.
The physician workforce shortage creates a competitive recruitment marketplace. This white paper offers practical advice on what to do today to focus your recruitment strategy for long-term success.
Case Review PaperThis assignment will need to be typed, double-s.docxbartholomeocoombs
Case Review Paper
This assignment will need to be typed, double-spaced with a cover page, font should be Times New Roman size 12, and inclusive of traditional (normal) one-inch margins. Any references you use need to be completed in APA formatting. For this assignment: (1) APA style must be used correctly, (2) All required relevant course readings and materials must be used, (3) At least 6 scholarly sources used (beyond course materials).The paper must be clear, well organized, and should be 10-15 pgs. not including cover page, references, and any other attachments.
This assignment provides an opportunity for students to complete a thorough case review of a client (Lisa). Students will assess Lisa’s case through a case study that provides several vignette’s regarding Lisa’s experience child welfare and substance usage. This case study illustrates the journey made by Lisa, a parent involved in the child welfare and addiction treatment systems. Students will follow Lisa through treatment program interviews and subsequent treatment, having to meet deadlines, and her recovery process with typical challenges and a relapse.
This assignment will allow you to demonstrate how you would distinguish, appraise, and integrate multiple sources of knowledge (including research –based knowledge and practice wisdom). Students will demonstrate their ability to apply Human Behaviors theories to guide basement and practice interventions. It is encouraged that you re-familiarize yourself with theories learned in Human Behaviors & Social Environment as well as Psychopathology courses (ex: Brief
Solution
Focused, Cognitive Behavioral Theory, Attachment Theory, Racial Identity Theory, Ego Psychology, Trauma Informed Theories).
Lisa’s story illustrates clinical issues, observations and decisions made by child welfare and addiction professionals, confidentiality processes and procedures, and decision points related to her children and competing requirements.
After reading Lisa’s Case Study (attached), please adhere to the following guidelines:
For this assignment, students will be expected to answer a series of questions that correspond to each stage of Lisa’s progress through the substance abuse child welfare system. These questions can be found at the bottom of every page of the case study.
Please be sure that your answer for each section is supported with peer-reviewed resources or course literature. Also, please remember to integrate course material throughout your answers.
There must be a theoretical support section in which students must
compare and contrast TWO theories and provide a through explanation and rationale for why one of the theories works best to support their work with the client.Please remember that you should specify the concepts and propositions from each theory that support, explain, and assist in your work with the client. Theories include
Respondent Learning theory, Operant Learning theory, Cognitive-Behavioral.
Pay Someone To Write An Essay - College. Online assignment writing service.Kristen Carter
The document discusses steps to pay someone to write an essay through the HelpWriting.net website. It involves creating an account, completing an order form with instructions and deadlines, and reviewing writer bids before choosing a writer and placing a deposit. The writer will submit a paper for review, and the client can request revisions until satisfied before authorizing full payment. HelpWriting.net promises original, high-quality content and refunds for plagiarized work.
Literary Essay Writing DIGITAL Interactive NotebKristen Carter
1. Submit account opening documents like KYC forms and bank details.
2. Place trade orders which are executed on the exchange.
3. Trades are settled on a T+2 basis, meaning payment is due within 2 working days of trade date.
4. Funds are transferred between broker and client bank accounts and shares are credited/debited to the demat account to complete settlement.
5. Regular monitoring of account, positions, and payments is required to ensure timely settlement.
1 3Defining the ProblemRigina CochranMPA593August 1.docxsmithhedwards48727
1
3Defining the Problem
Rigina CochranMPA/593
August 19, 2019
Peter ReevesDefining the Problem
The health care system in Colorado is a composition of medical professionals providing services such as diagnosis, treatment, as well as preventive measures to mental illness and injuries ("Healthcare policy in Colorado - Ballotpedia," 2019). Health care policy involves the establishment and implementation of legislation and other regulations that the states use to manage its health care system effectively. Further, this sector consists of other participants, such as insurance and health information technology. The cost citizens pay for medical care and also the access to quality care influence the overall health care providers in Colorado. Therefore, the need for the creation and implementation of laws that help the state maintain efficiency in the health sector in Colorado.
Problem Statement
The declining standards of medical care within the United States has caused significant concern in the world. Due to these rising concerns, there have been various policies implemented, leading to mixed reactions among the different states. Some of the active policies implemented offer a long-term solution to this problem including Medicaid and Medicare. After acquiring state control, the Republicans dismissed the idea to expand and create medical insurance for Medicaid in Colorado. Sustaining the structure of the health care payroll calls for the deductions from the employees and the employers, which may lead to loss of jobs and increased burden of expenditure (Garcia, 2019).
Identify the Methodology
The main objective of this policy plan is to investigate the role of legislation in the management of the health care sector in the United States. Due to the need for achieving in-depth exploration, this paper uses a combination of both qualitative and quantitative methods of data collection by addressing both practical and theoretical aspects of the research. Based on the answers that the policy requires, choosing survey as the research design. This method involves collecting and analyzing data from a few people who represent the principal group within health care. However, the survey method faces some challenges such as attitudes and perception of the health workers leading to the delimitation of the study. The target population for the study includes the nurses within the health sectors in Colorado. The selection of the participants involved in the use of stratified random sampling.
Identify your Stakeholders
The major stakeholders in the creation and implementation of the policy plan include the legislatures, local government, patients, and other private parties such as the insurance companies. Collectively, these bodies are involved in the making of thousands of decisions, overseeing hospitals, making budgetary appropriations, assisting the health workers to acquire licenses, determination of services that the insurers cover, and the management of.
April 2011In the fall of 2010, the Alliance for Health R.docxjewisonantone
April 2011
In the fall of 2010, the Alliance for Health
Reform, with support from the Robert
Wood Johnson Foundation, held a series of
Capitol Hill briefings on issues pertaining to
the health care workforce. The first brief-
ing in the series examined the physician
workforce. It looked at supply and demand
issues that may be changing as a result
of health reform. Panelists were: Edward
Salsberg, National Center for Workforce
Analysis, HRSA; Thomas Ricketts, Cecil G.
Sheps Center for Health Services Research,
University of North Carolina at Chapel Hill;
and Jay Crosson of the Kaiser Permanente
Institute for Health Policy. The second
briefing focused on nurses, allied health
professionals, direct care workers and the
various provisions of the health reform law
pertaining to them. Panelists were: Joel
Teitelbaum, George Washington University;
Bob Konrad, Cecil G. Sheps Center; Linda
Burnes Bolton, Cedars-Sinai Medical Center
and Catherine Dower, University of Califor-
nia, San Francisco.
Health Care Workforce:
Future Supply vs. Demand
Physician and nursing shortages
make headline news on a regular
basis. Debates continue in policy
circles among researchers, analysts
and stakeholders on whether the
shortages are due to insufficient
numbers of providers, or maldistri-
bution of those providers.
Experts also debate over whether
the solutions are to build more
schools and enlarge classes to
graduate more physicians, expand
the number of residency slots, find
incentives to attract providers to
health professional shortage areas,
or change the way we deliver care.
We begin to see the complexity of
analyzing the problem and matching
the solutions to the challenges if we
also consider:
• Is there an adequate and efficient
ratio of primary care providers to
specialists?
• Are we training for the right skills?
• Are those with skills using them to
their maximum potential?
• Where do nurses and licensed and
unlicensed allied health profession-
als fit into the picture?
Some key factors affecting
the adequacy of the health
care workforce include
growth in the insured
population as a result of the
health reform law, an aging
U. S. population, an aging
health care workforce, the
Fast Facts
n 40 percent of practicing physicians are older than 55; about one-third of
the nursing workforce is over age 50.
n Economists say a third of physicians could retire in the next 10 years.
n More than half of nurses over 50 say they plan to retire in the next de-
cade.
n Team-based care and an expanded role for advance practice nurses and
physician assistants could mitigate the shortage of primary care providers.
n The Institute of Medicine recommended, in October 2010, that nurses be
allowed to practice to the full extent of their education and training. Cur-
rently only eleven states allow nurse practitioners to practice independent
of a physician.
n Student medical school debt averages $.
April 2011In the fall of 2010, the Alliance for Health R.docxjustine1simpson78276
April 2011
In the fall of 2010, the Alliance for Health
Reform, with support from the Robert
Wood Johnson Foundation, held a series of
Capitol Hill briefings on issues pertaining to
the health care workforce. The first brief-
ing in the series examined the physician
workforce. It looked at supply and demand
issues that may be changing as a result
of health reform. Panelists were: Edward
Salsberg, National Center for Workforce
Analysis, HRSA; Thomas Ricketts, Cecil G.
Sheps Center for Health Services Research,
University of North Carolina at Chapel Hill;
and Jay Crosson of the Kaiser Permanente
Institute for Health Policy. The second
briefing focused on nurses, allied health
professionals, direct care workers and the
various provisions of the health reform law
pertaining to them. Panelists were: Joel
Teitelbaum, George Washington University;
Bob Konrad, Cecil G. Sheps Center; Linda
Burnes Bolton, Cedars-Sinai Medical Center
and Catherine Dower, University of Califor-
nia, San Francisco.
Health Care Workforce:
Future Supply vs. Demand
Physician and nursing shortages
make headline news on a regular
basis. Debates continue in policy
circles among researchers, analysts
and stakeholders on whether the
shortages are due to insufficient
numbers of providers, or maldistri-
bution of those providers.
Experts also debate over whether
the solutions are to build more
schools and enlarge classes to
graduate more physicians, expand
the number of residency slots, find
incentives to attract providers to
health professional shortage areas,
or change the way we deliver care.
We begin to see the complexity of
analyzing the problem and matching
the solutions to the challenges if we
also consider:
• Is there an adequate and efficient
ratio of primary care providers to
specialists?
• Are we training for the right skills?
• Are those with skills using them to
their maximum potential?
• Where do nurses and licensed and
unlicensed allied health profession-
als fit into the picture?
Some key factors affecting
the adequacy of the health
care workforce include
growth in the insured
population as a result of the
health reform law, an aging
U. S. population, an aging
health care workforce, the
Fast Facts
n 40 percent of practicing physicians are older than 55; about one-third of
the nursing workforce is over age 50.
n Economists say a third of physicians could retire in the next 10 years.
n More than half of nurses over 50 say they plan to retire in the next de-
cade.
n Team-based care and an expanded role for advance practice nurses and
physician assistants could mitigate the shortage of primary care providers.
n The Institute of Medicine recommended, in October 2010, that nurses be
allowed to practice to the full extent of their education and training. Cur-
rently only eleven states allow nurse practitioners to practice independent
of a physician.
n Student medical school debt averages $.
Summarize Competing Agendas for Healthcare Reform.pdfsdfghj21
The document discusses competing agendas for healthcare reform in the United States. It identifies individual and community barriers that contribute to inequitable access to Medicaid programs and services, such as race, income, education level, insurance status, and neighborhood factors. The Patient Protection and Affordable Care Act aims to address these issues by expanding Medicaid eligibility, funding new programs, and reducing barriers to healthcare access. However, state decisions to opt out of Medicaid expansion and federal budget cuts threaten to undermine some of the Affordable Care Act's efforts. The document also analyzes debates around the roles of the federal government, states, and private insurers in reforming the U.S. healthcare system.
This study is to focus attention on the extent to which the health care needs of
adolescents and young adults are being planned for and addressed as New York implements the Patient
Protection and Affordable Care Act (ACA)
According to this idea that gender is socially constructed, answer.docxronak56
According to this idea that gender is socially constructed, answer the following questions:
1. What does it mean to be a man in the U.S.? What does it mean to be a woman?
2. From what institutions do we learn these gender roles?
3. How do these clips demonstrate the ways in which gender is socially constructed in the U.S.? Do the concepts discussed in the clips resonate with you? Why or why not?
In Persepolis, the main character Marji struggles to define her identity as an Iranian woman in a changing society.
· What roles are depicted for women in Iranian society in the film? How do they change over time?
· How does Persepolis demonstrate the ways in which gender and identity are influenced in many ways, by different processes across cultures? How are gender roles in Iran similar, or different to gender in the U.S.?
· What are some of the stereotypes that exist about Muslim women and how does Abu-Lughod in “Do Muslim Women Need Saving” and Persepolis complicate these stereotypes?
Answer the following questions 2 full pages
Running head: MAJOR HEALTH CARE PROBLEMS IN THE U.S. 1
Major Health Care Problems in the U.S.
Jane Doe
ID: 1212121
MAJOR HEALTH CARE PROBLEMS IN THE U.S. 2
Major Health Care Problems in the US
Problem statement: High and continuously rising cost of health care has been and still is one of
the biggest challenges affecting the Health Care system in United States.
Methods of Examining the Problem
Both qualitative and quantitative research methods should be used to fully understand the
issue of high cost of care in the US. Quantitative methods like surveys and experimentations will
aid in estimating the prevalence, magnitude and frequency of the problem in different regions.
On the other hand, qualitative methods like case studies and observation will help describe the
extent and complexity of the issue. The two approaches need to work in complementation to
obtain a clear understanding of this menace.
Surveys, as a quantitative research method, is one of the most effective in the social
research and present a more viable method of examining the cost of health in the country. They
involve asking of questions in the form of questionnaires and interviews. Questionnaires are
written questions to which the response can be open ended or multiple-choice format. This
would be used to gain information about cost within determinants that are of
disagree/neutral/agree nature. An example is if patients are contented with the cost of services
they get or they deem the cost of cover worthy. Interviews, the researcher discussing issues with
the respondents, are to be used to gain more details on already known aspects of the system. This
may include gathering information to inform policies, administration and use of technology to
minimize the cost of care.
Since health cost in the US is not a new challenge and there have been studies about it,
qualitative methods like .
Report IIShawnette Jones MHA507Rea Burleson .docxaudeleypearl
Report II
Shawnette Jones
MHA/507
Rea Burleson
University of Phoenix
10/06/2019
Since the location of the highest widespread virus outbreaks have been recognized, it is important to know now what age group is mostly affected by the virus. Documenting these given age groups shall assist to determine the kinds of resources which shall be necessary at these locations to correctly treat these patients.
Age Groups Most Affected
Following the World Health Organization (2019) show that children, pregnant women and adults are particularly the ones who are vulnerable and take a relatively biggest share of the diseases load. The analysis of the given information, show that the progression of the age group most affected starting with the highest are under 18,61 and over 31-60 and finally 19-30 that correspond to the research of the World Health Organization on most vulnerable groups of individuals.
Age Groups Least Affected
The age groups least affected are the 19-30 years old in addition to those under 31- 60 years old. Generally, this kind of group comprises of the young adults as well as individuals in their middle ages. The reason why this group is probably least affected is due to the fact that this age brackets the body immune system is possibly more strong in preventing and fighting infections thus making the individual much healthier (Lesourd & Meaume, 1994).
Bar Graph Showing Ages Affected
Chart Evaluation
The bar graph above illustrates that the least age groups affected are ones between 19 to 30 years old. According to Morse (2001) explain that the observed age outlines can impact after intolerance diagnosing, identifying as well as cases recording, changes in exposure as well as variances invulnerability to the virus. Therefore by determining if change with age is contingent on exposure or vulnerability requires an evaluation of exposures in individual with and without the illness. Individual influences results to virus occurrences that can be recognized in nearly all incidents.
Prevalence Rates
The prevalence rate for this disease changes among the diverse age groups in every city. According to United States Census Bureau (2017) explanation the current population of the United States of America is 325,365,189 as of December 18, 2017. Therefore to determine the prevalence rate per 100,000 for this disease equals, the number of infection in the particular age group divided by the United States population, then multiplied by 100,000.
The following chart shows the prevalence rate for each age group in each of the top five cities affected by this disease.
City
<18 Prevalence Rate
19-30 Prevalence Rate
31-60 Prevalence Rate
61+ Prevalence Rate
Jacksonville
0.02858
0.00584
0.01875
0.04579
Miami
0.05225
0.00553
0.00922
0.02490
Phoenix
0.04457
0.00615
0.00984
0.02828
Austin
0.04641
0.00369
0.01199
0.02428
Houston
0.03012
0.00492
0.01598
0.03258
Conclusion
Finally, the study of age groups that are mainly affected and vulnera ...
Respond to at least two classmates who identified different areas of.docxpeggyd2
Respond to at least two classmates who identified different areas of disparity than your own. Do you agree or disagree with their assessment of the impact of economic policy on the disparity? Does the disparity discussed have a microeconomic or a macroeconomic impact on health care?
Post # 1
Trina Cox
Disparity in healthcare can be defined as, “differences between groups in health insurance coverage, access to and use of care, and quality of care” (Orger & Artiga, 2018). There are various healthcare disparities; however, the key areas of disparity I have chosen to identify and analyze include health insurance coverage, quality of care, and gender. As most people already know, health insurance is a type of insurance coverage that is designed to cover an insured person’s medical expenses (such as hospital, doctor, laboratory and pharmacy services). Although the number of uninsured Americans have decreased drastically since the passing of ACA, disparities in this area still exist. Some individuals’ annual incomes still are not enough to pay the low premiums that may be required of them to have access to health insurance coverage.
Quality of care can be described as, “the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (AHRQ, 2017). Although it is an unethical act displayed by healthcare professionals; in some areas, all patients are not treated equally with regards to quality of care. According to Dr. Ananya Mandal (2019), discrimination occurs when healthcare providers treat individuals from certain population groups differently to other population groups, whether this is done consciously or not. It is common for this to occur when providers have stereotyped impressions of specific racial or ethnic groups.
Gender can play a major role in healthcare disparities among women, specifically, in some of the developed countries. Researchers have reported that determinants of gender differences, like welfare indicators (e.g., education and income), behavioral factors (e.g., smoking and drinking), and social factors (e.g., social support and socioeconomic status) have direct correlations with some of the existing disparities (Hassanzadeh, et al, 2017). Afghanistan is a country that still has a high rate of gender disparities among women, even though some improvements have occurred. In this country, the biggest disparities that I feel still exist are between women in rural versus urban areas, and those with some education, as opposed to those women with none; showing that as education of women increases, so does their health and that of their children because of the education and resources that they have.
I think several economic policies have impacted these disparities and they include differences in income levels, education, and geographic location. A person’s annual income may have a direct effect on his or her ability.
This document discusses a data analysis task involving childhood obesity rates in different regions of the United States. The analysis will use data on the percentage of overweight and obese children ages 10-17 in each state. The states will be categorized into regions - East, South, Midwest, and West. A cluster analysis technique will be used to determine if there are trends in childhood obesity rates between different regions. If trends are found, government and healthcare organizations can focus obesity prevention programs on specific regions. The document provides background on the situation, data sources, and analysis methodology to be used.
1
Literature Review Assignment
STUDENT NAME
Class
Date
2
Part A: Annotated Bibliography
Article 1: Immigration as a Social Determinant of Health
Castañeda, H., Holmes, S. M., Madrigal, D. S., Young, M.-E. D., Beyeler, N., & Quesada, J.
(2015). Immigration as a Social Determinant of Health. Annual Review of Public
Health, 36(1), 375–392. doi: 10.1146/annurev-publhealth-032013-182419
Abstract
Although immigration and immigrant populations have become increasingly important foci in
public health research and practice, a social determinants of health approach has seldom been
applied in this area. Global patterns of morbidity and mortality follow inequities rooted in
societal, political, and economic conditions produced and reproduced by social structures,
policies, and institutions. The lack of dialogue between these two profoundly related
phenomena—social determinants of health and immigration—has resulted in missed
opportunities for public health research, practice, and policy work. In this article, we discuss
primary frameworks used in recent public health literature on the health of immigrant
populations, note gaps in this literature, and argue for a broader examination of immigration as
both socially determined and a social determinant of health. We discuss priorities for future
research and policy to understand more fully and respond appropriately to the health of the
populations affected by this global phenomenon.
Annotated Bibliography
The article reports on the importance of identifying social determinants and the effects of
socially determined structures among immigrant populations in the United States. The study
identifies ways in which immigrants health outcomes are based on biases due to using
3
information based on group behaviors instead of on an induvial case. The impact of migrant and
immigrant individuals, physical and mental health in these communities’ changes as social,
economic, and political policies take place. This article is helpful in that broadens the
immigration experience including more central factors than just language, income, or education
as the cause of all health related problems in this community. But to show factors of power
structures and the ability to put in place effective health interventions that respond to direct
causes of poor or declining health in these populations.
Article 2: Fear by Association: Perceptions of Anti-Immigrant Policy and Health Outcomes
Vargas, Edward & Sanchez, Gabriel & Juárez, Melina. (2017). Fear by Association: Perceptions
of Anti-Immigrant Policy and Health Outcomes. Journal of Health Politics, Policy and
Law. 42. 3802940. 10.1215/03616878-3802940.
Abstract
The United States is experiencing a renewed period of immigration and immigrant policy
activity as well as heightened enforcement of such policies. This intensified activity can affect
various aspects of im ...
The document summarizes the historical transition and growth of the U.S. health care system from the 19th century to present day. It discusses key milestones like the establishment of private health insurance in the 1930s and government programs Medicare and Medicaid in 1965. Major changes included the rise of HMOs in the 1980s and an increased focus on preventative care and reducing costs. The paper also examines challenges facing the system like an aging population as baby boomers require more care and changing demographics bringing new diseases. Financing and technology are seen as important factors enabling advancement, but affordability remains a challenge given high expenditures in the U.S. system.
This document describes a proposed randomized controlled trial to test the effectiveness of a health literacy and community health worker intervention for type 2 diabetes patients in community health centers. The study aims to address the gap in knowledge about how such interventions impact clinical outcomes like adherence, self-management, and communication. If shown to be effective, the intervention could help the millions of Americans with limited health literacy better manage their chronic conditions. The trial would involve community health centers in low-income neighborhoods of Boston serving predominantly minority populations disproportionately impacted by diabetes complications. Results could demonstrate cost-effective ways to incorporate health literacy and community health workers into standard care for medically underserved groups.
This document describes a study that examined how unmet basic needs cluster in low-income populations and how the effectiveness of health interventions may vary based on levels of unmet basic needs. The study analyzed data from a randomized controlled trial where low-income callers to a 211 helpline received cancer screening referrals along with one of three interventions: verbal referral only, verbal referral plus a printed reminder, or verbal referral plus navigation from a health coach. Latent class analysis identified three classes of unmet basic needs among participants. Logistic regression found that for those with relatively more or money-specific unmet needs, the navigator intervention was more effective at linking them to health referrals, while the printed reminder worked as well as the navigator for those
HCS 410(2) ACA Tittle IV-Prevention of Chronic diseasesMaria Jimenez
The document summarizes key aspects of the Affordable Care Act as it relates to prevention and wellness. It describes how the ACA aims to promote prevention, fund public health initiatives, and reduce chronic disease. It discusses provisions such as banning pre-existing condition exclusions, covering preventive services with no cost sharing, and investing in community-based prevention programs. However, it also notes that Republicans questioned whether these prevention initiatives were worth funding.
The December edition of the Professional Diversity Network Jobs Index & Report focuses on the Healthcare sector and the position of the diverse employee and candidate in this rapidly growing segment of the US economy.
DSmith_Increasing Prevention Utilization among African Americans_The_6_18_App...Denise Smith
This document provides a literature review and proposes a system-level solution to increase utilization of preventive services among African Americans. It summarizes approaches at the individual, provider, and system levels. At the system level, it advocates for the Centers for Disease Control and Prevention's 6|18 Initiative, which aims to rapidly adopt evidence-based interventions for six high-burden conditions disproportionately impacting African Americans through alignment of public health, clinical care, payers and providers. The initiative has potential to benefit millions of African Americans covered by Medicare and Medicaid.
DSmith_Increasing Prevention Utilization among African Americans_The 6 18 App...Denise Smith
This document provides an overview of approaches to increase the utilization of preventative services among African Americans, including interventions at the individual, provider, and system levels. It discusses challenges with purely individual behavioral change approaches, such as a lack of consideration for social determinants of health. At the provider level, value-based payment models that incentivize high-value preventative care show promise but face issues around a lack of consensus on what constitutes "value" and a need for more research on interventions proven to benefit African Americans specifically. The document argues that a system-level intervention like the CDC's 6|18 Initiative, which identifies high-burden preventable conditions affecting African Americans and coordinates public health prevention resources, shows the most promise
The document discusses key issues with the American healthcare system by analyzing three important exhibits. Exhibit 2 shows that while the US scores well on health outcomes, it performs poorly on access and efficiency compared to other countries. Exhibit 3 illustrates how the US spends nearly twice as much on healthcare than other nations without better quality. Exhibit 13 highlights the problem of nearly 47 million uninsured Americans lacking access to healthcare. Overall, the exhibits show the US healthcare system struggles with access, costs, and quality despite high spending, indicating managerial issues more than financial constraints.
The physician workforce shortage creates a competitive recruitment marketplace. This white paper offers practical advice on what to do today to focus your recruitment strategy for long-term success.
Case Review PaperThis assignment will need to be typed, double-s.docxbartholomeocoombs
Case Review Paper
This assignment will need to be typed, double-spaced with a cover page, font should be Times New Roman size 12, and inclusive of traditional (normal) one-inch margins. Any references you use need to be completed in APA formatting. For this assignment: (1) APA style must be used correctly, (2) All required relevant course readings and materials must be used, (3) At least 6 scholarly sources used (beyond course materials).The paper must be clear, well organized, and should be 10-15 pgs. not including cover page, references, and any other attachments.
This assignment provides an opportunity for students to complete a thorough case review of a client (Lisa). Students will assess Lisa’s case through a case study that provides several vignette’s regarding Lisa’s experience child welfare and substance usage. This case study illustrates the journey made by Lisa, a parent involved in the child welfare and addiction treatment systems. Students will follow Lisa through treatment program interviews and subsequent treatment, having to meet deadlines, and her recovery process with typical challenges and a relapse.
This assignment will allow you to demonstrate how you would distinguish, appraise, and integrate multiple sources of knowledge (including research –based knowledge and practice wisdom). Students will demonstrate their ability to apply Human Behaviors theories to guide basement and practice interventions. It is encouraged that you re-familiarize yourself with theories learned in Human Behaviors & Social Environment as well as Psychopathology courses (ex: Brief
Solution
Focused, Cognitive Behavioral Theory, Attachment Theory, Racial Identity Theory, Ego Psychology, Trauma Informed Theories).
Lisa’s story illustrates clinical issues, observations and decisions made by child welfare and addiction professionals, confidentiality processes and procedures, and decision points related to her children and competing requirements.
After reading Lisa’s Case Study (attached), please adhere to the following guidelines:
For this assignment, students will be expected to answer a series of questions that correspond to each stage of Lisa’s progress through the substance abuse child welfare system. These questions can be found at the bottom of every page of the case study.
Please be sure that your answer for each section is supported with peer-reviewed resources or course literature. Also, please remember to integrate course material throughout your answers.
There must be a theoretical support section in which students must
compare and contrast TWO theories and provide a through explanation and rationale for why one of the theories works best to support their work with the client.Please remember that you should specify the concepts and propositions from each theory that support, explain, and assist in your work with the client. Theories include
Respondent Learning theory, Operant Learning theory, Cognitive-Behavioral.
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The document discusses steps to pay someone to write an essay through the HelpWriting.net website. It involves creating an account, completing an order form with instructions and deadlines, and reviewing writer bids before choosing a writer and placing a deposit. The writer will submit a paper for review, and the client can request revisions until satisfied before authorizing full payment. HelpWriting.net promises original, high-quality content and refunds for plagiarized work.
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Here is a brief overview of the structure of education in the UK from early years to post-compulsory education:
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Here is a potential thesis and outline for an essay analyzing Robert Frost's poem "The Road Not Taken":
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Here are the key differences between university and school:
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The document summarizes a police report regarding an alleged assault involving Jordan Lundy and Alesha McCool. According to Lundy, McCool confronted and yelled at him at her home, then followed him into the street continuing to yell, where she pushed him hard enough to make him fall backwards and then slapped him. McCool provided a different account, saying Lundy was disrespectful and called her names, and that she only followed him outside to make sure he left the property. The officer collected statements from both parties involved in the reported assault.
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A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
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Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
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2015 HCM PACA Reform
1. A Regional Approach to Health
Care Reform
The Texas Border
Jose Luis Manzanares Rivera, ScD, MSc;
Genny Carrillo Zuniga, ScD, MD, MPH
The purpose of this article is to analyze health insurance disparities related to labor environment
factors in the Texas-Mexico border region. A logistic regression model was performed using
microdata from the 2010 American Community Survey to estimate the probability of having
employer-based insurance, controlling labor environment factors such as hours worked, occupa-
tion industry, and the choice of private, nonprofit or public sector jobs. Industries primarily
employing the Mexican American population are less likely to offer employer-based health in-
surance. These industries have the North American Industry Classification System (NAICS) code
770 construction, including cleaning, and NAICS code 8680, restaurants and other food services.
Although it was found that working in public sector industries such as code 9470, administration
of justice, public order, and safety, or NAICS code 7860, elementary and secondary schools, im-
proved by 60% the probability of the Mexican American population having employer-based health
insurance, these occupations ranked at the bottom of the main occupation list for Mexican
Americans. These findings provide evidence that the labor environment plays an important role in
understanding current health insurance access limitations within the Mexican American community
under 2010 Patient Protection and Affordable Care Act provisions, which are directed to small
business and lower-income individuals. Key words: health care, labor environment, Medicaid,
poverty, Texas border
HEALTH CARE REFORM as set forth by
the 2010 Patient Protection and Afford-
able Care Act, henceforth known as the ACA,
has been implemented in the United States
within its defined timeframe. However, among
the many debates generated regarding the ACA,
a particular provision of the bill, Medicaid Ex-
pansion, has created an intense debate across
the country. According to the ACA, effective
January1,2014,Americansyoungerthan65years
with incomes less than 133% of the federal pov-
erty level, became eligible to enroll in Medicaid
(Department of Health and Human Services, Eli-
gibility Changes, x435.912).
Considering that middle-class workers and
low-income Americans are the principal targets
of the ACA, the decision to opt out of Medicaid
Expansion by 15 US states (as of September 30,
2013)1
is an issue that merits academic attention.
Texas is one of the 15 states that chose to opt
out of Medicaid Expansion, which, from a public
policy perspective, presents a particularly inter-
esting case because 100 of its poorest counties
have the highest proportion of low per-capita
income in the entire country.1
These counties
are located in the South Texas region where
health issues have been the focus of attention for
decades and are characterized by high chronic
health disease prevalence such as diabetes2
and,
in some areas, the highest obesity rates nation-
wide.3
These types of public health issues are
important not only because they represent a
The Health Care Manager
Volume 34, Number 1, pp. 44–53
Copyright # 2015 Wolters Kluwer Health,
Inc. All rights reserved.
Author Affiliations: Department of Urban and
Environmental studies at El Colegio de la Frontera
Norte A.C., Mexico (Dr Rivera); and Environmental
and Occupational Health, Texas A&M Health Science
Center, School of Public Health (Dr Zuniga).
The authors have no conflict of interest.
Correspondence: Jose Luis Manzanares Rivera,
ScD, MSc, El Colegio de la Frontera Norte, Jalisco 1050,
Colonia Nisperos, Piedras Negras, Coahuila, México
(jlmanzanares@colef.mx).
DOI: 10.1097/HCM.0000000000000045
44
2. risk factor for the development of other chronic
conditions such as cancer and cardiovascular
disease,4
but also, given the socioeconomic sta-
tus in the South Texas region, health care af-
fordability issues, which are already significant,
are likely to be exacerbated.
While diverse studies have emerged related
to financial barriers for low-income population
groups and their impact on public insurance
programs such as Medicaid, the implications of
health insurance constraints go beyond this in-
surance program. While employer-based health
coverage is the main form of insurance provided
in the United States, it has barely been studied
from a regional perspective. Therefore, a study
of employer-based insurance may be key to un-
derstanding the situation faced by those in South
Texas.
In addition, labor environment characteristics
play a vital role among the provisions contained
in the ACA, in particular employer-based health
insurance; accordingly, understanding the differ-
ences in access between population groups may
be useful in order to evaluate benefits of the ACA
in specific areas of the country. This need be-
comes more evident in isolated social settings
such as the Texas-Mexico border, where a mix
of cultural patterns influences medical services
demand and health practices. Given these facts,
this article argues that a regional approach rep-
resents an opportunity to evaluate the effects of
health care reform at the local level, which, in
itself, is another challenge for health policy
design.
Using data drawn from the 2010 American
Community Survey (ACS), this study examines
patterns of insurance coverage along the Texas-
Mexico border, compares potential effects of
Medicaid Expansion against other regions of
the country that have already implemented this
provision, and provides an analysis of employer-
based health insurance demand among popula-
tion groups along the South Texas border.
PREVIOUS STUDIES
Why is a Texas regional approach case study
important to understanding the potential im-
pacts of ACA provisions such as Medicaid Ex-
pansion or changes in employer-based health
insurance? Social sciences literature and rural
sociology in particular indicate a consensus that
Texas represents a mix of at least 3 social factors
that make the state a relevant case study in the
context of health care reform. First, there is com-
pelling academic evidence concerning the health
challenges faced by the population in the Texas-
Mexico border region. Through empirical studies
about diabetes prevalence conducted by Hanis
et al2
(1983) to the work in 2010 by Fisher-
Hoch et al,3
it has been found that the ‘‘Rates of
obesity and diabetes in this border community
are among the highest in the United States.’’
Recent empirical evidence ‘‘concentrating on
the Hispanic population was developed that fol-
lows a public health approach and emphasizes
the correlation between obesity with metabolic
syndrome,’’5
a health condition associated in the
development of a series of chronic cardiovascular
health problems.
Second, based on the socioeconomic status
associated with particular population segments
in the southernmost part of the state, afford-
ability issues are likely to rise. A relatively vast
amount of work has been developed using a
constrained access perspective. Along these
lines, some authors emphasize the fact that some
population subgroups present considerably lower-
income levels relative to the rest of the popu-
lation,6
thus representing an important access
issue to the acquisition of private health insurance.
Adding to the debate on the high demand
and existence of financial barriers for public
health insurance has led some scholars to sug-
gest that this demand for public health insur-
ance encourages the development of a string
of studies related to Medicaid usage applying
the ‘‘crowding out’’ concept to document the
extent to which Medicaid demand expansions
reduce private insurance coverage.7-9
However,
in this research string, access to employer-
based health insurance, the main form of pri-
vate insurance in the United States, has been
limited and not explicitly considered for high-
demand populations, nor is it analyzed using a
desegregated approach that may yield useful
information in understanding how public pol-
icy actually works at the local level.
Third, Texas is a state with a demographic
composition that features the changing trends
Regional Approach to Health Care Reform 45
3. of the nation, with some population groups
becoming an increasing driving demand force
for health insurance both public and private,
in this instance Hispanics. From an empirical
perspective, the effects of health insurance con-
straints have been an issue of particular concern
in the literature for the United States–Mexico
border region.10-12
Studies such as that of Ortiz,
Arizmendi, and Cornelius using a nonproba-
bilistic sample of 271 individuals, argue that
‘‘. . .seeking care in Mexico may be a viable
solution for many people of Mexican descent
living in close geographic proximity to the bor-
der because it surmounts the political, cultural,
linguistic, or economic barriers to health care
services in the United States.’’13(p246)
Although Ortiz’s conclusions may not be gen-
eralizable, given the nature of his methodology
(he uses a nonprobabilistic small sample based
on face-to-face interviews in 2 counties of the
Lower Rio Grande Valley in Texas, Hidalgo, and
Pharr), his research highlights a practice already
common on the Texas-Mexico border, which is
that of cross-border demand for medical services.
With respect to urban areas on the border, the
study of Landeck and Garza14
estimates that
41.2% of Hispanics in the Laredo, Texas, area are
using physician health care services in Mexico.
However, using a different methodological ap-
proach (qualitative), other studies15
highlight
the cultural factor as an important determinant
of cross-border demand even in the presence of
US medical insurance.
Despite this fairly large body of work show-
ing the implications of access constraints on
health care in a binational context, a subset of
empirical research focusing on the relationship
between the labor environment and health in-
surance accessibility is still relatively scarce.16,17
Questions remain about labor environment de-
terminants of employer-based health insurance,
leading to a rise in academic attention.
It is argued that the labor force environment
deserves attention in order to explain access con-
straints for particular population groups. These
labor environment factors may include hours
worked, occupation industry, or the choice of
private nonprofit or public sector employment.
Other factors related to the labor structure
such as industry size have already been reported
as relevant access factors. According to informa-
tion based on the biennial health insurance sur-
vey conducted by The Common Wealth Fund,
‘‘54% of workers in industry with fewer than
50 employees who earned less than $15 an
hour reported being uninsured during 2010.’’18
Moreover, given the provisions on accessibility
directed to small business and low-income pop-
ulations set forth by the ACA, labor environment
determinants of employer-based health insur-
ance become a relevant issue, particularly for
the border region.
In some respects, these academic efforts con-
stitute a multidisciplinary bridge for studying
the relationship between the rising cost of care,
higher prevalence rates of health issues among
minorities, and the need for regional multidisci-
plinary research. As some authors from a broader
social science perspective indicate, the focus on
the unique social position of minorities in rural
areas presents an opportunity from which much
can be learned.19
CONSIDERATIONS ABOUT THE
PATIENT PROTECTION AND
AFFORDABLE CARE ACT
The ACA is a comprehensive set of rules for
the US health care system that has been imple-
mented in successive stages. It not only makes
changes in eligibility, but also considers health
insurance adjustments for employers, private
insurance companies, and pharmaceutical manu-
facturers. Three provisions are particularly rel-
evant for the population living on the Texas-
Mexico border:
(1) Effective 2014, Medicaid expanded cover-
age for the lowest income populations, that is,
‘‘coverage for individuals with income at or be-
low 133% of the poverty line.20
(2) Small Business Health Options Program
and small business health care affordability tax
credits. These provisions are of special interest
for the region given the labor market structure.
The first Small Business Health Options Pro-
gram strategy aims to reduce the administrative
burden that small businesses face when offer-
ing health plans. Whereas the tax credit strategy
will ‘‘. . .provide tax credit to small employers
with fewer than 25 employees and average
46 THE HEALTH CARE MANAGER/JANUARY–MARCH 2015
4. annual wages of less than $50000 that pur-
chase health insurance for employees, the full
credit will be available to employers with 10 or
fewer employees and average annual wages
of less than $25000. To be eligible for a tax
credit, the employer must contribute at least
50% of the total premium cost.’’21(p69)
(3) Access to insurance for uninsured individuals
with a preexisting condition.21(p30)
This provi-
sion refers to access to coverage that does not
impose exclusions for preexisting health con-
ditions, before the ACA insurers could exclude
health care coverage based on preexisting health
conditions, for example, diabetes.
Given the historically high prevalence rates
of chronic diseases such as diabetes in the
area,21
this is of particular interest among the
Mexican population living on the Texas bor-
der. Predisposition to diabetes for the Mexican
American population has been extensively docu-
mented since the 1980s. At that time, ‘‘prevalence
and mortality rates for non–insulin-dependent
(type 2) diabetes mellitus [were] 2 to 5 times
greater than those found in the general US
population.22
METHODS
A logistic regression model is implemented
based on cross-section Public Use Microdata
(PUMS) from the 2010 ACS.
Public Use Microdata from the 2010 ACS was
analyzed. This data set was selected given its
disaggregation level, which allows for distin-
guishing between first- and second-generation
Mexican origin population. The sample for the
state contained 741823 observations. Once the
sampling weight was applied, representative es-
timations were obtained for specific geographic
areas.
Data analysis
The statistical analysis was conducted in 3
parts: The first was descriptive and explored
the characteristics of the Mexican origin pop-
ulation in terms of access to health coverage
on the Texas-Mexico border area. The second
was inferential focusing on Medicaid coverage
and determined the expected change in demand
caused by expansion of the poverty eligibility
threshold set out by the ACA. The third part
examined employer-based health insurance by
analyzing labor environment determinants using
a logistic regression approach. The data were
analyzed using STATA 11 (StataCorp, College
Station, Texas) software to fully integrate survey
characteristics in order to obtain statistical rep-
resentative estimates.
Geographic area selection
Based on Medicaid enrollment statistics, a
total of 34 counties on the Texas-Mexico bor-
der, which on average comprise the highest
Medicaid enrollment levels in the State, were
considered. There are 4 major population cen-
ters in the area with adjacent urban locations
on the Mexican side, with Hispanics representing
an average of 90% more than the total. These
cities are El Paso-Cd. Juárez, Laredo-Nuevo
Laredo, McAllen-Reynosa, and Brownsville-
Matamoros.23
Descriptive statistics for health
insurance coverage
Health insurance programs in the United
States can be classified as public or private. The
4 major public health programs reported in the
ACS are Medicare, Medicaid, VA, and TRICARE.
Medicaid alone covers 23.4% of the total popu-
lation in the study area, representing 661873
enrollments.24
Private insurance refers to coverage either
purchased directly from a private company or
provided by an employer. The primary source of
health insurance in the study area and the United
States is employer based and covered 988994
individuals or 32.75% of the total population in
the study area.25
However, a state-level compar-
ison in the study area revealed an important gap
in employer-based health insurance. Whereas the
employer-based coverage rate for the state is
an average of 52.13%, the coverage rate in the
study area is only 32.75%. This gap is partially
absorbed through public coverage via Medic-
aid (10.43%). In this case, the rate of coverage
of 25.5% is higher than the state level of 15.07%,
in what appears to be a crowding-out effect
as applied to the interaction between private
Regional Approach to Health Care Reform 47
5. and public health insurance by other authors
elsewhere.25
The implications of such regional patterns
for the Medicaid Expansion debate become
clear from a national perspective when consid-
ering the projected Medicaid expenditure at the
national level already reaches US $281 billion, or
1.8% of GDP, for fiscal year 2013, with an esti-
mated increase of 130% within the next de-
cade. (According to the Congressional Budget
Office, Medicaid expenditure is projected to
reach US $605 billion, or 2.5% of GDP, by the
beginning of the next decade, a 130% increase
in just 10 years.)26
The concentration of Med-
icaid enrollment on the border region is shown
in Figure 1.
Descriptive statistics for coverage rates among
population subgroups in the region revealed that
the Mexican American population presented the
lowest coverage rates in the private insurance
category: 53% when compared with 78% of the
non-Hispanic white population group, or 70%
for the African American population. In contrast,
Mexican Americans showed the highest rate of
Medicaid enrollment rates with a proportion
almost 7 times higher than the non-Hispanic
white population, and close to 3 times as much
as the African American subgroup.25
These
gaps depict access disparities between popu-
lation subgroups and highlight the importance
of employer-based health insurance as a resource
for improving insurance coverage for popula-
tion groups that are already placing a high de-
mand on public programs.
The Medicaid Expansion scenario in Texas
as originally proposed by the ACA was to cover
those individuals with incomes up to 133% of
the federal poverty level, thereby reducing ac-
cess restrictions for the Mexican American pop-
ulation in the region by increasing the eligibility
base by 22%. Although alternative strategies to
overcome access limitations such as cross-border
demand27,28
have recently been documented in
the literature, given such factors as geographic
proximity to Mexican cities, price differentials,
and cultural affinity, the state alternative to Med-
icaid Expansion to the Medicaid program de-
signed to benefit low-income individuals remains
a key issue for minority population groups in
the area.
Figure 1. Medicaid enrollment by county, 2013. Source: Authors using data from Texas Department of State Health
Services, Texas Health and Human Services Commission, and US Census TiGER Line Shp.
48 THE HEALTH CARE MANAGER/JANUARY–MARCH 2015
6. Employer-based health insurance
demands: a logistic regression approach
As noted in previous studies, the lack of
health coverage seems to be primarily associ-
ated with financial barriers as well as to labor
environment structure as defined by a company’s
size,29,30
type of employment, and other labor
environment factors. In order to more closely
analyze this relationship, a logistic model was
constructed to evaluate underlying labor en-
vironment determinants for employer-based
health insurance in the area. The logistic model
is specified in Equations (1) and (2).
PðEmp insr ¼ 1jx1; x2:::xkÞ ¼
1
ð1þð þ i xi ÞÞ
ð1Þ
PðE insr ¼ 1jx1; x2:::xkÞ ð2Þ
¼
1
ð1 þ eð þ 1wkhþ 2class wrkþ 3industryþ 4pop grpÞÞ
The binary response variable for employer-
based insurance (Emp_insr) measured whether
the individual had employer-based health insur-
ance and used the values 1 if the response was
affirmative and 0 otherwise. The explanatory
variables were as follows: weekly work hours
(wkh), which referred to hours worked per
week by the individual and was put into 3 cate-
gories: (1) part-time, between 1 and 32 hours;
(2) full-time regular, between 33 and 48 hours;
and (3) extended, between 49 and 60 hours.
Variable class work (class_wrk) refers to type
of employment and is placed in 4 categories:
(1) private for-profit company or business; (2)
. . .sector (local, state, or federal level); (3)
entrepreneur (working in own business); and
(4) private nonprofit, tax-exempt, or charitable
organization. Variable ‘‘industry’’ refers to the
industry in which the individual worked. To
record this variable, the top 5 industries by em-
ployment were based on their North American
Industry Classification System (NAICS) code, using
the following categorical transformation: 1,
NAICS code 7860 (elementary and secondary
schools); 2, NAICS code 770 (construction, in-
cluding cleaning during and after); 3, NAICS
code 8680 (restaurants and other food services);
4, NAICS code 9470 (justice, public order, and
safety activities); 5, NAICS code 8170 (med-home
health care services).
To identify possible differences across pop-
ulation groups a control variable ‘‘pop_grp’’
was introduced in the model and included 3
categories: (1) non-Hispanic white population, (2)
second-generation Mexican American population,
and (3) first-generation Mexican American Popula-
tion. Results from the regression are shown in the
Table.
Table. Labor Environment Determinants for Employer-Based Health Insurance
Employer-Provided Health Insurance Odds Ratio SE z P z 95% Confidence Interval
Class work
Public 3 1.17 2.83 0.01 1.4-6.43
Entrepreneur 0.73 0.83 0.28 0.78a
0.08-6.84
Nonprofit 3.69 2.12 2.27 0.02 1.2-11.37
Weekly work hours
Full time 2.73 0.76 3.58 0 1.58-4.72
Extended 5.49 2.38 3.93 0 2.35-12.83
Industry
Construction 0.27 0.11 3.26 0 0.12-0.59
Restaurants 0.33 0.15 2.45 0.01 0.14-0.8
Justice, public order 1.14 0.36 0.4 0.68b
0.61-2.13
Home health care 0.31 0.16 2.22 0.03 0.11-0.87
Population groups
Second-generation Mexican American 0.43 0.13 2.8 0.01 0.23-0.77
First-generation Mexican American 0.25 0.09 3.78 0 0.12-0.51
Constant 0.77 0.39 0.53 0.6 0.28-2.07
Coefficients are statistically significant at .05, unless otherwise specified.
a,b
Not statistically significant. Dependable variable: employer-provided health insurance. R2
= 0.2861, P 2
= 0.
Regional Approach to Health Care Reform 49
7. The model parameters show that the vari-
ables selected were statistically significant de-
terminants to explain employer-based health
insurance. The coefficients from the regression
are already expressed as the change in the odds
ratios from the base category. The base categories
are as follows: class work: private sector; weekly
work hours: part time (1-32 hours); industry:
education, elementary and secondary schools;
and population group: non-Hispanic white.
Results were validated against specification
errors using the Turkey test (linktest) whose
purposes in this case were (1) to test the lo-
gistic function adequacy as a link function
between the outcome and predictor variables
and (2) to detect if there are important ex-
plicative variable omissions in relation to the
dependent variable.31(p16)
Standard postestimation tests were conducted
and included the Hosmer and Lemeshow
goodness-of-fit test32
and the multicolinearity
test, in which no indication of unusual values
for the variance inflation factor or tolerance
was found; therefore, multicolinearity issues
were discarded. In order to have a precise es-
timation of the probabilities associated with
the model odds ratios, a marginal effects esti-
mation was conducted and applied to estimate
Equation (3).
E½yjx=xj ¼ expðx
0
þ jÞ expðx
0
Þ
¼ expðx
0
Þðebj
1Þ ð3Þ
Marginal effects at representative values (MER)
instead of the conventional marginal effects at
means values (MEM) method was used to take
advantage of interactions between indepen-
dent variables for specific values.
RESULTS
There are important differences in the
probability of having employer-based health
insurance in respect to the population group
an individual belongs to. For example, an
individual in the non-Hispanic white group
has a 60.6% probability of having this type of
health insurance, whereas an individual in the
second-generation Mexican American group
has a 46.5% probability. The difference is still
more pronounced in the case of individuals in
the first-generation Mexican American group,
where the probability is 37.6%. This pattern
prevails across all industries (Figure 3).
Furthermore, when interaction with the var-
iable industry of employment is included, the
chance of second-generation Mexican Americans
obtaining employer-based health insurance im-
proves dramatically if they work in 2 specific
industries: the administration of justice, public
order, and safety industry, or in the elementary
and secondary school industry, with probabilities
of 59.4% and 56.7%, respectively. Comparing
against the other main industries in the area,
which are construction and restaurants and
other food services, an important disadvantage
for second-generation Mexican Americans can
be noted given the probabilities of only 29.7%
and 33.8%, respectively, for these types of jobs.
Inallcases,second-generationMexicanAmericans
have a higher probability of having employer-
based health insurance than the first-generation
Figure 2. Estimated probabilities by population group and industry/employer-provided health insurance 2010.
Source: Authors using public use microdata from ACS, US Census Bureau 2010. *2gMxA refers to
second-generation Mexican American.
50 THE HEALTH CARE MANAGER/JANUARY–MARCH 2015
8. subgroup, which could be an indication of the
education and acculturation process (Figure 2).
Regarding the class of work, the estimation
suggested that working for a private nonprofit,
tax-exempt, or charitable organization is a good
way to acquire health coverage because at 60%
this category presents the highest probability of
receiving this benefit within the class-of-work
categories, which is higher than the probability
for the public sector at 56%. On the other hand,
working for the private sector is the less attrac-
tive option among the 4 classes of work consid-
ered, with the lowest probability of having health
insurance provided by an employer at only 34%
(Figure 3).
Concerning the number of hours worked
per week, a positive correlation was confirmed
between the probabilities of having employer-
based health insurance and the number of hours
worked per week. However, an interaction with
the class of work revealed an interesting fact,
which is that even a part-time employee in the
private nonprofit, tax-exempt, or charitable orga-
nization category had a better chance of having
employer-based health insurance at 42.6% than
a full-time private sector employee in the study
area where the probability is only 19%.
Overall model results provided additional
information toward understanding the lack of
access due to nonfinancial barriers on the de-
mand for health insurance. According to the
logistic regression results, the private sector pre-
sents the lowest probability of having employer-
based health insurance. Within the private sector,
2 key industries where insurance constraints pre-
vailed among the Mexican American community
were construction and restaurants. The fact that
2 of 5 second-generation Mexican American
adults in the study area work in occupations
within these 2 industries provides evidence of
insurance coverage constraints faced by the
Mexican American community on the Texas-
Mexico border.
DISCUSSION
The results from the analysis of the labor mar-
ket determinates suggest that the provisions for
small business tax credits in the ACA may have
a balance effect regarding public and private
insurance coverage disparities, rather than a
crowding-out scenario induced by the increase
in Medicaid enrollees among the Mexican
American community.
Although further evaluation of this is needed,
the magnitude of this effect will be constrained
by the characteristics of the Mexican American
population labor force participation, given that
labor environment determinants of private health
insurance and the occupational characteristics
of the Mexican American population largely ex-
plain the lack of employer-based insurance access
in the Texas-Mexico border area.
Furthermore, results indicate that industries
in which the Mexican American population is
primarily employed are characterized by the
lowest probability of having insurance. Those
industries are NAICS code 770 (construction,
including cleaning) and NAICS code 8680 (res-
taurants and other food services).
Although it was found that working in public
sector industries such as code 9470 (administration
Figure 3. Estimated probabilities by class of work and hours worked per week/employer-provided health insurance
2010. Source: Authors using public use microdata from ACS, US Census Bureau 2010.
Regional Approach to Health Care Reform 51
9. of justice, public order, and safety activities) or
NAICS code 7860 (elementary and secondary
schools) improved by a 60% probability the
opportunities of Mexican Americans obtaining
employer-based health insurance, these occupa-
tions rank at the bottom of the main occupation
list for Mexican Americans.
In addition, consistent with previous studies
describing existing pressures on public programs
such as Medicaid,33,34
the study revealed an
important gap in employer-based insurance in
relation to the State of Texas coverage level,
which is partially absorbed by a 10.43% overload
for public coverage via Medicaid in the study
area. According to the results, the ACA provision
regarding poverty eligibility levels may generate
in the area a further increase in demand for this
program with an additional 621000 potential
new beneficiaries of whom 481000 are second-
generation Mexican Americans and 140000 in
the first generation.
This scenario does not favor the State of Texas
implementation of an alternative Medicaid Expan-
sion, which in turn may generate an additional
incentive for cross-border demand of medical
services already evident given the price differ-
entials and cultural similarities between border
localities, practice that could have an adverse
effect on health care quality as implied in recent
studies conducted on the border region.35,36
Limitations
Although no previous study linking the af-
fordable care provisions with the labor envi-
ronment for the Mexican American population
has been published to our knowledge, the anal-
ysis presents a series of limitations, regarding the
microdata used, first as a disclosure avoidance
measure the most detailed unit of geography
contained in the PUMS files is the Public Use
Microdata Area. Public Use Microdata Areas are
special nonoverlapping areas that partition each
state into geographic units containing no fewer
than 100000 people each; this implies that the
analysis cannot be replicated at a county level,
which would be of interest for other parts of
the country with high proportion of Mexican
American populations. Instead, to conduct a
statistical representative analysis at regional level,
Public Use Microdata Area geographies should
be selected to match the region of study, as was
the case for the present article.
Finally, Public Use Microdata from the ACS
does not provide information about the firm
size in which individuals are employed, so com-
plementary sources need to be developed to
more closely analyze public policy impacts.
CONCLUSIONS
This study shows that ACA provisions directed
to small business and lower-income individuals
have the potential to reduce health insurance
constraints among the Mexican American com-
munity. Positive externalities may include a di-
minishing incentive for cross-border demand of
medical services in the event that an alternative
Medicaid Expansion is enacted in Texas.
Regarding labor environment, because the selec-
tion of industry or sector appears to be important
determinants of employer-based health insur-
ance, other factors such as the gradual shift in the
occupational pattern toward occupations of higher
human capital appear to be an important element
within the Mexican American community; how-
ever, this issue warrants further evaluation.
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